f4-tcrm-4-705: Coronary angiogram from the patient diabetes mellitus with developed unstable angina one week after that magnetic resonance imaging investigation suggested presence of significant coronary disease. Notice tight narrowing (arrow) in the proximal segment of left anterior descending artery (LAD).

Mentions: DM patients have shown strong tendency for increased LV mass. No difference in stroke volume (SV) and ejection fraction (EF) was found between the groups (Table 2) suggesting preserved systolic function. Delayed-enhancement MRI revealed the presence of subendocardial infarction in two patients (13%) from the DM group. In the first patient there was evidence of small subendocardial infarction located anteriorly while in the second patient subendocardial infarction was located inferiorly. No signs of myocardial damage were detected in the control subjects. In addition MR coronary angiography showed high-grade stenosis in the proximal portion of the left anterior descending (LAD) coronary artery in one DM patient. Interestingly, this patient developed unstable angina expressed as acute chest pain and ST-segment depression one week after MRI investigation and underwent acute revascularization with percutaneous coronary intervention. The conventional coronary angiography confirmed the presence of culprit lesion in the LAD (Figure 4). One DM patient with subendocardial MI have shown presence of significant coronary artery stenosis on MR angiography in LAD and right coronary artery. The other DM patient with presence MI had normal MR coronary angiogram. No significant coronary artery disease was detected in the control group on MR angiogram. If we combine these two findings—ie, presence of myocardial scar and significant coronary artery disease—than our MRI protocol detected important cardiac abnormalities in 20% of asymptomatic DM patients.

Omerovic E, Brohall G, Müller M, Råmunddal T, Matejka G, Waagstein F, Fagerberg B - Ther Clin Risk Manag (2008)

Bottom Line: The conventional angiography has confirmed the presence of significant stenosis in LAD demanding invasive revascularization by percutaneous coronary angioplasty.No difference was found in indices of left ventricular (LV) systolic function while diastolic function was disturbed in the DM group.MRI screening of these high risk female patient is valuable diagnostic tool which may increase diagnostic accuracy and improve prognosis in DM patients with IHD.

Affiliation: The Wallenburg Laboratory at Sahlgrenska Academy, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg University, 413 45, Gothenburg, Sweden Department of Cardiology and Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. elmir@wlab.gu.se

Abstract: The aim of this study was to investigate whether asymptomatic women with diabetes mellitus (DM) without previous history of ischemic heart disease (IHD) and normal electrocardiogram (ECG) have suffered silent myocardial infarction (MI).The study population consisted of 64-years old women with DM and albuminuria (n = 15) and aged- and body mass index-matched controls (n = 16). The patients were selected after screening of 240 women with previously known or unknown DM. The individuals with previous history of IHD and ECG suggesting the presence of IHD were excluded. All subjects were investigated with magnetic resonance imaging (MRI).MRI investigation has revealed the presence of subendocardial MI in the two DM women (13%). No MI was detected in the control group. MR coronary angiography detected the presence of significant stenosis in the proximal segment of left anterior descending (LAD) coronary artery in one DM woman. This patient developed unstable angina 1 week after the MRI investigation. The conventional angiography has confirmed the presence of significant stenosis in LAD demanding invasive revascularization by percutaneous coronary angioplasty. No difference was found in indices of left ventricular (LV) systolic function while diastolic function was disturbed in the DM group. There was a tendency for increased LV mass in the DM group. No difference was found in the LV volumes.Clinically significant proportion of the women with DM and albuminuria without previous history of IHD have had silent MI. MRI screening of these high risk female patient is valuable diagnostic tool which may increase diagnostic accuracy and improve prognosis in DM patients with IHD.