Top

Published in:

Open Access 01-09-2008 | Review

Non-invasive cardiac imaging techniques and vascular tools for the assessment of cardiovascular disease in type 2 diabetes mellitus

Authors: R. Djaberi, E. D. Beishuizen, A. M. Pereira, T. J. Rabelink, J. W. Smit, J. T. Tamsma, M. V. Huisman, J. W. Jukema

Published in: Diabetologia | Issue 9/2008

Abstract

Cardiovascular disease is the major cause of mortality in type 2 diabetes mellitus. The criteria for the selection of those asymptomatic patients with type 2 diabetes who should undergo cardiac screening and the therapeutic consequences of screening remain controversial. Non-invasive techniques as markers of atherosclerosis and myocardial ischaemia may aid risk stratification and the implementation of tailored therapy for the patient with type 2 diabetes. In the present article we review the literature on the implementation of non-invasive vascular tools and cardiac imaging techniques in this patient group. The value of these techniques as endpoints in clinical trials and as risk estimators in asymptomatic diabetic patients is discussed. Carotid intima–media thickness, arterial stiffness and flow-mediated dilation are abnormal long before the onset of type 2 diabetes. These vascular tools are therefore most likely to be useful for the identification of ‘at risk’ patients during the early stages of atherosclerotic disease. The additional value of these tools in risk stratification and tailored therapy in type 2 diabetes remains to be proven. Cardiac imaging techniques are more justified in individuals with a strong clinical suspicion of advanced coronary heart disease (CHD). Asymptomatic myocardial ischaemia can be detected by stress echocardiography and myocardial perfusion imaging. The more recently developed non-invasive multi-slice computed tomography angiography is recommended for exclusion of CHD, and can therefore be used to screen asymptomatic patients with type 2 diabetes, but has the associated disadvantages of high radiation exposure and costs. Therefore, we propose an algorithm for the screening of asymptomatic diabetic patients, the first step of which consists of coronary artery calcium score assessment and exercise ECG.

Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H (2001) Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 44(Suppl 2):S14–21PubMedCrossRef

Buse JB, Ginsberg HN, Bakris GL et al (2007) Primary prevention of cardiovascular diseases in people with diabetes mellitus. A scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 30:162–172PubMedCrossRef

Graf S, Gariepy J, Massonneau M et al (1999) Experimental and clinical validation of arterial diameter waveform and intimal media thickness obtained from B-mode ultrasound image processing. Ultrasound Med Biol 25:1353–1363PubMedCrossRef

Burke GL, Evans GW, Riley WA et al (1995) Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) Study. Stroke 26:386–391PubMed

O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr (1999) Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 340:14–22PubMedCrossRef

Chambless LE, Heiss G, Folsom AR et al (1997) Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 146:483–494PubMed

Niskanen L, Rauramaa R, Miettinen H, Haffner SM, Mercuri M, Uusitupa M (1996) Carotid artery intima–media thickness in elderly patients with NIDDM and in nondiabetic subjects. Stroke 27:1986–1992PubMed

Bonora E, Kiechl S, Oberhollenzer F et al (2000) Impaired glucose tolerance, type II diabetes mellitus and carotid atherosclerosis: prospective results from the Bruneck Study. Diabetologia 43:156–164PubMedCrossRef

Lee CD, Folsom AR, Pankow JS, Brancati FL, Atherosclerosis Risk in Communities (ARIC) Study Investigators (2004) Cardiovascular events in diabetic and nondiabetic adults with or without history of myocardial infarction. Circulation 109:855–860PubMedCrossRef

10.

Wagenknecht LE, Zaccaro D, Espeland MA, Karter AJ, O’Leary DH, Haffner SM (2003) Diabetes and progression of carotid atherosclerosis: the insulin resistance atherosclerosis study. Arterioscler Thromb Vasc Biol 23:1035–1041PubMedCrossRef

11.

van der Meer IM, Iglesias del Sol A, Hak AE, Bots ML, Hofman A, Witteman JC (2003) Risk factors for progression of atherosclerosis measured at multiple sites in the arterial tree: the Rotterdam Study. Stroke 34:2374–2379PubMedCrossRef

12.

Bernard S, Sérusclat A, Targe F et al (2005) Incremental predictive value of carotid ultrasonography in the assessment of coronary risk in a cohort of asymptomatic type 2 diabetic subjects. Diabetes Care 28:1158–1162PubMedCrossRef

13.

Yamasaki Y, Kodama M, Nishizawa H et al (2000) Carotid intima–media thickness in Japanese type 2 diabetic subjects: predictors of progression and relationship with incident coronary heart disease. Diabetes Care 23:1310–1315PubMedCrossRef

14.

Folsom AR, Chambless LE, Duncan BB, Gilbert AC, Pankow JS, Atherosclerosis Risk in Communities Study Investigators (2003) Prediction of coronary heart disease in middle-aged adults with diabetes. Diabetes Care 26:2777–2784PubMedCrossRef

15.

Benetos A, Laurent S, Hoeks AP, Boutouyrie PH, Safar ME (1993) Arterial alterations with aging and high blood pressure. A noninvasive study of carotid and femoral arteries. Arterioscler Thromb 13:90–97PubMed

16.

Fukui M, Kitagawa Y, Nakamura N et al (2003) Augmentation of central arterial pressure as a marker of atherosclerosis in patients with type 2 diabetes. Diabetes Res Clin Pract 59:153–161PubMedCrossRef

17.

Weber T, Auer J, O’Rourke MF et al (2004) Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation 109:184–189PubMedCrossRef

18.

Henry RM, Kostense PJ, Spijkerman AM et al (2003) Arterial stiffness increases with deteriorating glucose tolerance status: the Hoorn Study. Circulation 107:2089–2095PubMedCrossRef

19.

Wilkinson IB, Fuchs SA, Jansen IM et al (1998) Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis. J Hypertens 16:2079–84PubMedCrossRef

20.

Lakatta EG, Levy D (2003) Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a ‘set up’ for vascular disease. Circulation 107:139–146PubMedCrossRef

21.

Simons PC, Algra A, Bots ML, Grobbee DE, van der Graaf Y (1999) Common carotid intima–media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of ARTerial disease). Circulation 100:951–957PubMed

22.

Störk S, van den Beld AW, von Schacky C et al (2004) Carotid artery plaque burden, stiffness, and mortality risk in elderly men: a prospective, population-based cohort study. Circulation 110:344–348PubMedCrossRef

23.

Willum-Hansen T, Staessen JA, Torp-Pedersen C et al (2006) Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 113:664–670PubMedCrossRef

24.

Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG (2002) Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 106:2085–2090PubMedCrossRef

25.

Schram MT, Henry RM, van Dijk RA et al (2004) Increased central artery stiffness in impaired glucose metabolism and type 2 diabetes: the Hoorn Study. Hypertension 43:176–181PubMedCrossRef

26.

Hatsuda S, Shoji T, Shinohara K et al (2006) Regional arterial stiffness associated with ischemic heart disease in type 2 diabetes mellitus. J Atheroscler Thromb 13:114–121PubMed

27.

Joannides R, Haefeli WE, Linder L et al (1995) Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation 91:1314–1319PubMed

28.

Anderson TJ, Uehata A, Gerhard MD et al (1995) Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol 26:1235–1241PubMedCrossRef

29.

Hijmering ML, Stroes ES, Pasterkamp G, Sierevogel M, Banga JD, Rabelink TJ (2001) Variability of flow mediated dilation: consequences for clinical application. Atherosclerosis 157:369–373PubMedCrossRef

30.

De Roos NM, Bots ML, Schouten EG, Katan MB (2003) Within-subject variability of flow-mediated vasodilation of the brachial artery in healthy men and women: implications for experimental studies. Ultrasound Med Biol 29:401–406PubMedCrossRef

31.

Schroeder S, Enderle MD, Ossen R et al (1999) Noninvasive determination of endothelium-mediated vasodilation as a screening test for coronary artery disease: pilot study to assess the predictive value in comparison with angina pectoris, exercise electrocardiography, and myocardial perfusion imaging. Am Heart J 138:731–739PubMedCrossRef

32.

Gokce N, Keaney JF Jr, Hunter LM et al (2003) Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease. J Am Coll Cardiol 41:1769–1775PubMedCrossRef

33.

Fathi R, Haluska B, Isbel N, Short L, Marwick TH (2004) The relative importance of vascular structure and function in predicting cardiovascular events. J Am Coll Cardiol 43:616–623PubMedCrossRef

34.

Creager MA, Lüscher TF, Cosentino F, Beckman JA (2003) Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation 108:1527–1532PubMedCrossRef

35.

Tan KC, Chow WS, Ai VH, Metz C, Bucala R, Lam KS (2002) Advanced glycation end products and endothelial dysfunction in type 2 diabetes. Diabetes Care 25:1055–1059PubMedCrossRef

36.

Nitenberg A, Pham I, Antony I, Valensi P, Attali JR, Chemla D (2005) Cardiovascular outcome of patients with abnormal coronary vasomotion and normal coronary arteriography is worse in type 2 diabetes mellitus than in arterial hypertension: a 10 year follow-up study. Atherosclerosis 183:113–120PubMedCrossRef

37.

Schmermund A, Baumgart D, Görge G et al (1998) Measuring the effect of risk factors on coronary atherosclerosis: coronary calcium score versus angiographic disease severity. J Am Coll Cardiol 31:1267–1273PubMedCrossRef

38.

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMed

39.

Allison MA, Wright CM (2005) Age and gender are the strongest clinical correlates of prevalent coronary calcification (R1). Int J Cardiol 98:325–330PubMedCrossRef

40.

Elkeles RS, Feher MD, Flather MD et al (2004) The association of coronary calcium score and conventional cardiovascular risk factors in type 2 diabetic subjects asymptomatic for coronary heart disease (The PREDICT Study). Diabet Med 21:1129–1134PubMedCrossRef

41.

Hoff JA, Quinn L, Sevrukov A et al (2003) The prevalence of coronary artery calcium among diabetic individuals without known coronary artery disease. J Am Coll Cardiol 41:1008–1012PubMedCrossRef

42.

Schurgin S, Rich S, Mazzone T (2001) Increased prevalence of significant coronary artery calcification in patients with diabetes. Diabetes Care 24:335–338PubMedCrossRef

43.

Reaven PD, Sacks J, Investigators for the VADT (2005) Coronary artery and abdominal aortic calcification are associated with cardiovascular disease in type 2 diabetes. Diabetologia 48:379–385PubMedCrossRef

44.

Raggi P, Cooil B, Ratti C, Callister TQ, Budoff M (2005) Progression of coronary artery calcium and occurrence of myocardial infarction in patients with and without diabetes mellitus. Hypertension 46:238–243PubMedCrossRef

45.

Raggi P, Shaw LJ, Berman DS, Callister TQ (2004) Prognostic value of coronary artery calcium screening in subjects with and without diabetes. J Am Coll Cardiol 43:1663–1669PubMedCrossRef

46.

Qu W, Le TT, Azen SP et al (2003) Value of coronary artery calcium scanning by computed tomography for predicting coronary heart disease in diabetic subjects. Diabetes Care 26:905–910PubMedCrossRef

47.

Mollet NR, Cademartiri F, Krestin GP et al (2005) Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography. J Am Coll Cardiol 45:128–132PubMedCrossRef

48.

Hoffmann MH, Shi H, Schmitz BL et al (2005) Noninvasive coronary angiography with multislice computed tomography. JAMA 293:2471–2478PubMedCrossRef

49.

Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557PubMedCrossRef

50.

Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323PubMedCrossRef

51.

Ropers D, Rixe J, Anders K et al (2006) Usefulness of multidetector row spiral computed tomography with 64- × 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 97:343–348PubMedCrossRef

52.

Hoffmann U, Moselewski F, Nieman K et al (2006) Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol 47:1655–1662PubMedCrossRef

53.

Pundziute G, Schuijf JD, Jukema JW et al (2007) Noninvasive assessment of plaque characteristics with multislice computed tomography coronary angiography in symptomatic diabetic patients. Diabetes Care 30:1113–1119PubMedCrossRef

54.

Schuijf JD, Bax JJ, Jukema JW et al (2004) Noninvasive angiography and assessment of left ventricular function using multislice computed tomography in patients with type 2 diabetes. Diabetes Care 27:2905–2910PubMedCrossRef

55.

Schuijf JD, Mollet NR, Cademartiri F et al (2006) Do risk factors influence the diagnostic accuracy of noninvasive coronary angiography with multislice computed tomography? J Nucl Cardiol 13:635–641PubMedCrossRef

56.

Scholte AJ, Schuijf JD, Kharagjitsingh AV et al (2008) Prevalence of coronary artery disease and plaque morphology assessed by multi-slice computed tomography coronary angiography and calcium scoring in asymptomatic patients with type 2 diabetes. Heart 94:290–295PubMedCrossRef

57.

Crawford MH, Mendoza CA, O’Rourke RA, White DH, Boucher CA, Gorwit J (1978) Limitations of continuous ambulatory electrocardiogram monitoring for detecting coronary artery disease. Ann Intern Med 89:1–5PubMed

58.

Ochotny R, Luczak D, Górski L, Błaszczyk K, Jasek S, Koźbiał H (1992) 24-Hour ECG monitoring by the Holter system in early diagnosis of coronary disease. Pol Arch Med Wewn 87:265–270 (article in Polish)PubMed

59.

Nair CK, Khan IA, Esterbrooks DJ, Ryschon KL, Hilleman DE (2001) Diagnostic and prognostic value of Holter-detected ST-segment deviation in unselected patients with chest pain referred for coronary angiography: a long-term follow-up analysis. Chest 120:834–839PubMedCrossRef

60.

Quyyumi A, Crake T, Wright C, Mockus L, Fox K (1987) The role of ambulatory ST-segment monitoring in the diagnosis of coronary artery disease: comparison with exercise testing and thallium scintigraphy. Eur Heart J 8:124–129PubMed

61.

Sajadieh A, Nielsen OW, Rasmussen V, Hein HO, Hansen JF (2005) Prevalence and prognostic significance of daily-life silent myocardial ischaemia in middle-aged and elderly subjects with no apparent heart disease. Eur Heart J 26:1402–1409PubMedCrossRef

62.

Chiariello M, Indolfi C, Cotecchia MR, Sifola C, Romano M, Condorelli M (1985) Asymptomatic transient ST changes during ambulatory ECG monitoring in diabetic patients. Am Heart J 110:529–534PubMedCrossRef

63.

Aronow WS, Mercando AD, Epstein S (1992) Prevalence of silent myocardial ischemia detected by 24-hour ambulatory electrocardiography, and its association with new coronary events at 40-month follow-up in elderly diabetic and nondiabetic patients with coronary artery disease. Am J Cardiol 69:555–556PubMedCrossRef

64.

Marín Huerta E, Rayo I, Lara JI et al (1989) Silent myocardial ischemia during Holter monitoring in patients with diabetes mellitus. Rev Esp Cardiol 42:519–529 (article in Spanish)PubMed

65.

Caracciolo EA, Chaitman BR, Forman SA et al (1996) Diabetics with coronary disease have a prevalence of asymptomatic ischemia during exercise treadmill testing and ambulatory ischemia monitoring similar to that of nondiabetic patients. An ACIP database study. ACIP Investigators. Asymptomatic Cardiac Ischemia Pilot Investigators. Circulation 93:2097–2105PubMed

66.

Ahluwalia G, Jain P, Chugh SK, Wasir HS, Kaul U (1995) Silent myocardial ischemia in diabetics with normal autonomic function. Int J Cardiol 48:147–153PubMedCrossRef

67.

Gianrossi R, Detrano R, Mulvihill D et al (1989) Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation 80:87–98PubMed

68.

Roger VL, Jacobsen SJ, Pellikka PA, Miller TD, Bailey KR, Gersh BJ (1998) Prognostic value of treadmill exercise testing: a population-based study in Olmsted County, Minnesota. Circulation 98:2836–2841PubMed

69.

Laukkanen JA, Kurl S, Lakka TA et al (2001) Exercise-induced silent myocardial ischemia and coronary morbidity and mortality in middle-aged men. J Am Coll Cardiol 38:72–79PubMedCrossRef

70.

Giagnoni E, Secchi MB, Wu SC et al (1983) Prognostic value of exercise EKG testing in asymptomatic normotensive subjects. A prospective matched study. N Engl J Med 309:1085–1089PubMed

71.

Paillole C, Ruiz J, Juliard JM, Leblanc H, Gourgon R, Passa P (1995) Detection of coronary artery disease in diabetic patients. Diabetologia 38:726–731PubMedCrossRef

72.

Bacci S, Villella M, Villella A et al (2002) Screening for silent myocardial ischaemia in type 2 diabetic patients with additional atherogenic risk factors: applicability and accuracy of the exercise stress test. Eur J Endocrinol 147:649–654PubMedCrossRef

73.

Janand-Delenne B, Savin B, Habib G, Bory M, Vague P, Lassmann-Vague V (1999) Silent myocardial ischemia in patients with diabetes: who to screen. Diabetes Care 22:1396–1400PubMedCrossRef

74.

Cosson E, Paycha F, Paries J et al (2004) Detecting silent coronary stenoses and stratifying cardiac risk in patients with diabetes: ECG stress test or exercise myocardial scintigraphy? Diabet Med 21:342–348PubMedCrossRef

75.

Gerson MC, Khoury JC, Hertzberg VS, Fischer EE, Scott RC (1988) Prediction of coronary artery disease in a population of insulin-requiring diabetic patients: results of an 8-year follow-up study. Am Heart J 116:820–826PubMedCrossRef

76.

Kim C, Kwok YS, Heagerty P, Redberg R (2001) Pharmacologic stress testing for coronary disease diagnosis: a meta-analysis. Am Heart J 142:934–944PubMedCrossRef

77.

Bartunek J, Marwick TH, Rodrigues AC et al (1996) Dobutamine-induced wall motion abnormalities: correlations with myocardial fractional flow reserve and quantitative coronary angiography. J Am Coll Cardiol 27:1429–1436PubMedCrossRef

78.

Marwick TH, Nemec JJ, Pashkow FJ, Stewart WJ, Salcedo EE (1992) Accuracy and limitations of exercise echocardiography in a routine clinical setting. J Am Coll Cardiol 19:74–81PubMed

79.

Arruda-Olson AM, Juracan EM, Mahoney DW, McCully RB, Roger VL, Pellikka PA (2002) Prognostic value of exercise echocardiography in 5,798 patients: is there a gender difference? J Am Coll Cardiol 39:625–631PubMedCrossRef

80.

McCully RB, Roger VL, Mahoney DW et al (1998) Outcome after normal exercise echocardiography and predictors of subsequent cardiac events: follow-up of 1,325 patients. J Am Coll Cardiol 31:144–149PubMedCrossRef

81.

Marwick TH, Case C, Short L, Thomas JD (2003) Prediction of mortality in patients without angina: use of an exercise score and exercise echocardiography. Eur Heart J 24:1223–1230PubMedCrossRef

82.

Elhendy A, van Domburg RT, Poldermans D et al (1998) Safety and feasibility of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients unable to perform an exercise stress test. Diabetes Care 21:1797–1802PubMedCrossRef

83.

Hennessy TG, Codd MB, Kane G, McCarthy C, McCann HA, Sugrue DD (1997) Evaluation of patients with diabetes mellitus for coronary artery disease using dobutamine stress echocardiography. Coron Artery Dis 8:171–174PubMedCrossRef

84.

Faglia E, Manuela M, Antonella Q et al (2005) Risk reduction of cardiac events by screening of unknown asymptomatic coronary artery disease in subjects with type 2 diabetes mellitus at high cardiovascular risk: an open-label randomized pilot study. Am Heart J 149:e1–6PubMedCrossRef

85.

Iskandrian AS, Verani MS (1996) Exercise perfusion imaging in coronary artery disease: physiology and diagnosis. In: Nuclear cardiac imaging: principles and applications. Davis, Philadelphia, pp 73–143

86.

Thomas GS, Miyamoto MI, Morello AP 3rd et al (2004) Technetium 99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting. The Nuclear Utility in the Community (NUC) Study. J Am Coll Cardiol 43:213–223PubMedCrossRef

87.

Fleg JL, Gerstenblith G, Zonderman AB et al (1990) Prevalence and prognostic significance of exercise-induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers. Circulation 81:428–436PubMed

88.

Elhendy A, Schinkel A, Bax JJ, van Domburg RT, Poldermans D (2003) Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study. J Nucl Cardiol 10:261–266PubMedCrossRef

89.

Kang X, Berman DS, Lewin H et al (1999) Comparative ability of myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in patients with and without diabetes mellitus. Am Heart J 137:949–957PubMedCrossRef

90.

Rajagopalan N, Miller TD, Hodge DO, Frye RL, Gibbons RJ (2005) Identifying high-risk asymptomatic diabetic patients who are candidates for screening stress single-photon emission computed tomography imaging. J Am Coll Cardiol 45:43–49PubMedCrossRef

91.

Miller TD, Rajagopalan N, Hodge DO, Frye RL, Gibbons RJ (2004) Yield of stress single-photon emission computed tomography in asymptomatic patients with diabetes. Am Heart J 147:890–896PubMedCrossRef

92.

Wackers FJ, Young LH, Inzucchi SE et al (2004) Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 27:1954–1961PubMedCrossRef

93.

Sultan A, Piot C, Mariano-Goulart D et al (2006) Myocardial perfusion imaging and cardiac events in a cohort of asymptomatic patients with diabetes living in southern France. Diabet Med 23:410–418PubMedCrossRef

94.

Zellweger MJ, Hachamovitch R, Kang X et al (2004) Prognostic relevance of symptoms versus objective evidence of coronary artery disease in diabetic patients. Eur Heart J 25:543–550PubMedCrossRef

95.

Valensi P, Pariès J, Brulport-Cerisier V et al (2005) Predictive value of silent myocardial ischemia for cardiac events in diabetic patients: influence of age in a French multicenter study. Diabetes Care 28:2722–2727PubMedCrossRef

96.

Nitenberg A, Ledoux S, Valensi P, Sachs R, Attali JR, Antony I (2001) Impairment of coronary microvascular dilation in response to cold pressor-induced sympathetic stimulation in type 2 diabetic patients with abnormal stress thallium imaging. Diabetes 50:1180–1185PubMedCrossRef

97.

O’Keefe JH Jr, Barnhart CS, Bateman TM (1995) Comparison of stress echocardiography and stress myocardial perfusion scintigraphy for diagnosing coronary artery disease and assessing its severity. Am J Cardiol 75:25D–34DPubMedCrossRef

98.

Anand DV, Lim E, Hopkins D et al (2006) Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy. Eur Heart J 27:713–721PubMedCrossRef

99.

Moreno PR, Murcia AM, Palacios IF et al (2000) Coronary composition and macrophage infiltration in atherectomy specimens from patients with diabetes mellitus. Circulation 102:2180–2184PubMed

100.

Detrano R, Guerci AD, Carr JJ et al (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 27:1336–1345CrossRef

Title: Non-invasive cardiac imaging techniques and vascular tools for the assessment of cardiovascular disease in type 2 diabetes mellitus
Authors: R. Djaberi
E. D. Beishuizen
A. M. Pereira
T. J. Rabelink
J. W. Smit
J. T. Tamsma
M. V. Huisman
J. W. Jukema
Publication date: 01-09-2008
Publisher: Springer-Verlag
Published in: Diabetologia / Issue 9/2008
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-008-1062-4

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 9/2008

Alcohol consumption and risk of microvascular complications in type 1 diabetes patients: the EURODIAB Prospective Complications Study

Intravitreous anti-VEGF for diabetic retinopathy: hopes and fears for a new therapeutic strategy

Congenital rubella: citation virus or viral cause of type 1 diabetes?

Performance of the revised ‘175’ Modification of Diet in Renal Disease equation in patients with type 2 diabetes

Is a nutritional therapeutic approach unsuitable for metabolically healthy but obese women?

Increased fat:carbohydrate oxidation ratio in Il1ra −/− mice on a high-fat diet is associated with increased sympathetic tone

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials