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(Circulation. 2002;105:5.)
© 2002 American Heart Association, Inc.

Editorials

Detection of Myocardial Ischemia in Patients With Diabetes Mellitus

Frans J. Th. Wackers, MD; Barry L. Zaret, MD

From the Section of Cardiovascular Medicine, Department of Internal Medicine, and Section of Nuclear Medicine, Department of Diagnostic Radiology, Yale University School of Medicine.

Correspondence to Frans J.T. Wackers, MD, Section of Cardiovascular Medicine, Yale University School of Medicine, 333 Cedar St, 3 FMP, New Haven, CT 06520-8017. E-mail frans.wackers@diagrad.med.yale.edu

Key Words: Editorials • diabetes mellitus • ischemia • radioisotopes • imaging

The combination of clinical coronary artery disease and diabetes mellitus is a harbinger of adverse outcome. Recently, in a jointly issued statement, the American Diabetes Association, the National Heart, Lung, and Blood Institute, the Juvenile Diabetes Foundation International, the National Institute of Diabetes and Digestive and Kidney Diseases, and the American Heart Association indicated the importance of diabetes mellitus as a major risk factor for cardiovascular disease.^1,2 Patients with diabetes mellitus often have premature coronary artery disease; the disease is often asymptomatic and in an advanced stage when detected.³ In general, the outcome of patients with diabetes mellitus is poorer than those without diabetes, and coronary artery disease in the diabetic patient may be less amenable to favorable interventional treatment compared with the nondiabetic population.^4–6 Moreover, it seems that in women with diabetes mellitus and coronary artery disease, overall outcome has not improved to the extent observed in men, despite aggressive medical or interventional treatment.⁷ Such observations have led to the need for more aggressive approaches to preventive, diagnostic, and therapeutic strategies in patients with diabetes mellitus.

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Stress radionuclide myocardial perfusion imaging (MPI) is used widely to evaluate patients with suspected or known coronary artery disease. A large body of evidence attests to the high diagnostic yield of stress MPI and its important incremental prognostic value over both clinical and angiographic variables for the prediction of major acute coronary events.^8,9 The degree and extent of myocardial perfusion abnormalities observed on stress MPI are related directly to outcome. . . . [Full Text of this Article]

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