Abstract 3088: The Resting Electrocardiogram in Type 2 Diabetes: A Useful Screening Tool for Asymptomatic Coronary Artery Disease?
Despite the high risk of asymptomatic coronary artery disease (CAD) in diabetes (DM), factors identifying individuals who might benefit from CAD screening have not yet been identified. Abnormalities on resting electrocardiograms (rECG), including axis deviation (AD), conduction defects (CD), left ventricular hypertrophy (LVH), and minor Q-waves and ST-T abnormalities, and their association with race, gender and stress-induced ECG and myocardial perfusion imaging (MPI) abnormalities were examined in 342 subjects in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study using Minnesota Code criteria. Mean age was 60±6 years, DM duration 8±7 years; 55% were male and none had known or suspected CAD; AD was found in 5%, CD in 9%, LVH in 3%, Q-waves in 12%, and abnormal ST-segments in 4% or T-waves in 15%. LVH was found most frequently in African-American (AA) males (25%; p < .0001) and T-wave abnormalities in both AA males and AA females (30%; p = .005). Overall, minor Q-waves (19%; p = .03), T-wave (25%; p = .01) and ST-segment (10%; p = .01) abnormalities were associated with stress-induced ECG or MPI abnormalities. In multivariate logistic regression analyses, T-wave (OR = 2.1; 95% CI 1.1,4.3; p = .04) and ST-segment (OR = 4.3; 95% CI 1.3,14.2; p = .02) abnormalities, along with an abnormal Valsalva ratio (OR = 3.4; 95% CI 1.8,6.3; p = .0002), a measure of cardiac autonomic neuropathy previously identified as a risk marker, and male gender (OR = 2.0; 95% CI 1.1,3.6; p = .02) remained independent predictors of a stress-induced ECG or MPI abnormality. In conclusion, the rECG, along with the presence of cardiac autonomic neuropathy, and male gender, but not race, may help to identify individuals with type 2 DM who may benefit from additional screening for CAD.