A Novel Screening Tool to Diagnose Silent Myocardial Infarction in Type 2 Diabetes


Dr Ambrish Mithal    14 October 2017

Researchers from the UK have devised a novel and practical 4-component screening tool to diagnose silent myocardial infarction (MI) in patients with type 2 diabetes, which had significantly superior diagnostic accuracy than current electrocardiogram (ECG) criteria to detect silent MI in asymptomatic patients. The test had an 82% sensitivity and 72% specificity for silent MI.The study included 100 patients with type 2 diabetes who had no history of known heart disease and were asymptomatic. These patients underwent ECG, echocardiography, biomarker assessment and cardiac Magnetic resonance imaging (MRI) including assessment of left ventricular ejection fraction and late gadolinium enhancement. The four parameters included in the screening tool were age, E/A ratio, global longitudinal strain (GLS) and N-terminal pro-brain natriuretic peptide (NT-proBNP). The optimum cut-off measures for these components were:Age ≥62 years, E/A ratio ≤0.7, GLS of at least 18.4% and NT-proBNP >29 ng/L. Seventeen patients with no history of heart disease had silent MI defined by late gadolinium enhancement in an infarct pattern on cardiac MRI. Only four patients with silent MI had Q waves on ECG. All patients who scored 0 or 1 were free of MI. Of the 16 patients who scored 4, seven had experienced a silent MI and nine had not. Patients with silent MI were older, had lower E/A ratio, lower GLS and higher NT-proBNP levels. The findings of the study were presented at the European Association for the Study of Diabetes (EASD) 2016 Annual Meeting in Munich, Germany.

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