Screening of silent myocardial ischemia in asymptomatic diabetic patients: ROle of coronary artery calcium and stress myocardial perfusion scintigraphy

Background Coronary artery diseases and heart failure are the main causes of morbimortality in diabetes. Screening of silent myocardial ischemia in asymptomatic diabetic patients is very important and is still controversial. Coronary artery calcium (CAC) belongs to innovative technology in non-invasive imagery technique based on tomography without injection and permits cardiovascular risk assessment; its threshold usually is 400. Purpose Principal objective was to diagnose silent myocardial ischemia in asymptomatic diabetics based on CAC measurement. A secondary objective was to determine patients’ characteristics when CAC was  Methods CAC imaging was performed in every asymptomatic diabetic patient and all patients with CAC ≥ 400 underwent myocardial perfusion scintigraphy. Results Two hundred and sixty-three patients were included between 2014 and 2017. Eighty patients had a CAC score ≥ 400 and sixty-two of them underwent myocardial perfusion scintigraphy. Silent myocardial ischemia was detected in 14 patients (5%). The predictors of elevated CAC were: age, male gender, hypertension, duration of diabetes, dyslipidemia and microalbuminuria. Conclusion In this study, evaluating silent ischemia screening, CAC followed by myocardial scintigraphy have an important role in cardiovascular risk assessment. Thirty percent of patients required an imaging test such as perfusion scintigraphy and 5% had silent myocardial ischemia. CAC and myocardial perfusion scintigraphy can improve screening and risk stratification in this population. CAC score can help to guide medical treatment.