Volume 4, Issue 2, June 2020, Page: 34-46
The Degree of Retinopathy Correlates with the Presence of Silent Myocardial Ischemia in Diabetic Patients
Ehab El-Hefny, Faculty of Medicine, Al Azhar University, Cairo, Egypt
Abdel Mageed Tag El-Din, Faculty of Medicine, Al Azhar University, Cairo, Egypt
Ayman Sadek, Faculty of Medicine, Al Azhar University, Cairo, Egypt
Eslam Abbas, Oncocardiology Department, Dar El Salam Cancer Center, Cairo, Egypt
Received: Feb. 28, 2020;       Accepted: Mar. 16, 2020;       Published: Apr. 21, 2020
DOI: 10.11648/j.ccr.20200402.12      View  298      Downloads  87
Abstract
Background: Silent myocardial ischemia is a major component of the total ischemic burden for patients with ischemic heart disease. The disease is more prevalent in diabetic patients than their peers, and early detection of the high-risk group would play an integral role in the prevention of sudden cardiovascular accidents that are common in these patients. Methods: A prospective cohort study including asymptomatic 53 diabetic patients with diabetic retinopathy who suffer no ischemic cardiac symptoms was conducted. The presence and degree of diabetic retinopathy were evidenced using fundus examination and optical coherence tomography. All the enrolled patients underwent stress-resting 99mTc SestaMIBI myocardial perfusion scintigraphy to detect the ischemic burden. The relation between diabetic retinopathy and silent myocardial ischemia was stratified using statistical analysis. Results: A total of 13 diabetic patients (24.5%) have silent myocardial ischemia in the form of regional myocardial perfusion abnormalities. The strongest predictors of abnormal tests were the presence of moderate to severe retinopathy, comorbid hypertension and diabetic duration for more than 10 years. Conclusion: Silent myocardial ischemia affects one in four asymptomatic diabetic patients suffering from diabetic retinopathy. The presence of comorbid risk factors such as high-grade retinopathy, hypertension and/or long diabetic duration surge the incidence and considered additional predictors of the disease.
Keywords
Diabetic Retinopathy, Silent Myocardial Ischemia, Optical Coherence Tomography, Myocardial Perfusion Imaging
To cite this article
Ehab El-Hefny, Abdel Mageed Tag El-Din, Ayman Sadek, Eslam Abbas, The Degree of Retinopathy Correlates with the Presence of Silent Myocardial Ischemia in Diabetic Patients, Cardiology and Cardiovascular Research. Vol. 4, No. 2, 2020, pp. 34-46. doi: 10.11648/j.ccr.20200402.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
N. Cheung, J. J. Wang, R. Klein, D. J. Couper, A. R. Sharrett, T. Y. Wong, Diabetic retinopathy and the risk of coronary heart disease: the Atherosclerosis Risk in Communities Study, Diabetes Care. 30 (2007) 1742–1746.
[2]
K. Gu, C. C. Cowie, M. I. Harris, Diabetes and decline in heart disease mortality in US adults, Jama. 281 (1999) 1291–1297.
[3]
R. S. Rosenson, P. Fioretto, P. M. Dodson, Does microvascular disease predict macrovascular events in type 2 diabetes?, Atherosclerosis. 218 (2011) 13–18.
[4]
G. Targher, L. Bertolini, L. Zenari, G. Lippi, I. Pichiri, G. Zoppini, M. Muggeo, G. Arcaro, Diabetic retinopathy is associated with an increased incidence of cardiovascular events in Type 2 diabetic patients, Diabet. Med. 25 (2008) 45–50.
[5]
T. Tsujimoto, H. Kajio, Y. Takahashi, M. Kishimoto, H. Noto, R. Yamamoto-Honda, M. Kamimura, M. Morooka, K. Kubota, T. Shimbo, Asymptomatic coronary heart disease in patients with type 2 diabetes with vascular complications: a cross-sectional study, BMJ Open. 1 (2011) e000139.
[6]
BARI Investigators, Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI), Circulation. 96 (1997) 1761–1769.
[7]
BARI Investigators, Seven-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic status, J. Am. Coll. Cardiol. 35 (2000) 1122–1129.
[8]
M. V Van Hecke, J. M. Dekker, C. D. A. Stehouwer, B. C. P. Polak, J. H. Fuller, A. K. Sjolie, A. Kofinis, R. Rottiers, M. Porta, N. Chaturvedi, Diabetic retinopathy is associated with mortality and cardiovascular disease incidence: the EURODIAB prospective complications study, Diabetes Care. 28 (2005) 1383–1389.
[9]
O. Torffvit, M. Lövestam‐Adrian, E. Agardh, C. Agardh, Nephropathy, but not retinopathy, is associated with the development of heart disease in type 1 diabetes: a 12‐year observation study of 462 patients, Diabet. Med. 22 (2005) 723–729.
[10]
B. E. K. Klein, R. Klein, P. E. McBride, K. J. Cruickshanks, M. Palta, M. D. Knudtson, S. E. Moss, J. O. Reinke, Cardiovascular disease, mortality, and retinal microvascular characteristics in type 1 diabetes: Wisconsin epidemiologic study of diabetic retinopathy, Arch. Intern. Med. 164 (2004) 1917–1924.
[11]
M. Cusick, A. D. Meleth, E. Agrón, M. R. Fisher, G. F. Reed, G. L. Knatterud, F. B. Barton, M. D. Davis, F. L. Ferris, E. Y. Chew, Associations of mortality and diabetes complications in patients with type 1 and type 2 diabetes: early treatment diabetic retinopathy study report no. 27, Diabetes Care. 28 (2005) 617–625.
[12]
C. L. Hanis, H.-H. Chu, K. Lawson, D. Hewett-Emmett, S. A. Barton, W. J. Schull, C. A. Garcia, Mortality of Mexican Americans with NIDDM: retinopathy and other predictors in Starr County, Texas, Diabetes Care. 16 (1993) 82–89.
[13]
H. Miettinen, S. M. Haffner, S. Lehto, T. Rönnemaa, K. Pyörälà, M. Laakso, Retinopathy predicts coronary heart disease events in NIDDM patients, Diabetes Care. 19 (1996) 1445–1448.
[14]
M. V Van Hecke, J. M. Dekker, G. Nijpels, A. C. Moll, H. A. Van Leiden, R. J. Heine, L. M. Bouter, C. D. A. Stehouwer, B. C. P. Polak, Retinopathy is associated with cardiovascular and all-cause mortality in both diabetic and nondiabetic subjects: the hoorn study, Diabetes Care. 26 (2003) 2958.
[15]
J. H. Fuller, L. K. Stevens, S. L. Wang, W. H. O. M. S. Group, Risk factors for cardiovascular mortality and morbidity: The WHO multinational study of vascular disease in diabetes., Diabetologia. 44 (2001) S54.
[16]
R. Klein, B. E. K. Klein, S. E. Moss, K. J. Cruickshanks, Association of ocular disease and mortality in a diabetic population, Arch. Ophthalmol. 117 (1999) 1487–1495.
[17]
R. Kawasaki, N. Cheung, F. M. A. Islam, R. Klein, B. E. K. Klein, M. F. Cotch, A. R. Sharrett, D. O’Leary, T. Y. Wong, M.-E. S. of Atherosclerosis, Is diabetic retinopathy related to subclinical cardiovascular disease?, Ophthalmology. 118 (2011) 860–865.
[18]
M. J. Koistinen, Prevalence of asymptomatic myocardial ischaemia in diabetic subjects., BMJ. 301 (1990) 92–95.
[19]
C. J. Ditchburn, J. A. Hall, M. de Belder, A. Davies, W. Kelly, R. Bilous, Silent myocardial ischaemia in patients with proved coronary artery disease: a comparison of diabetic and non-diabetic patients, Postgrad. Med. J. 77 (2001) 395–398.
[20]
G. Rose, P. McCartney, D. D. Reid, Self-administration of a questionnaire on chest pain and intermittent claudication., J. Epidemiol. Community Heal. 31 (1977) 42–48.
[21]
Early Treatment Diabetic Retinopathy Study Research Group, Photocoagulation for diabetic macular edema, Arch Ophthalmol. 103 (1985) 1796–1806.
[22]
A. Patz, R. E. Smith, The ETDRS and diabetes 2000, Ophthalmology. 98 (1991) 739–740.
[23]
P. Royle, H. Mistry, P. Auguste, D. Shyangdan, K. Freeman, N. Lois, N. Waugh, Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation, (2015).
[24]
R. Nakazato, B. K. Tamarappoo, X. Kang, A. Wolak, F. Kite, S. W. Hayes, L. E. J. Thomson, J. D. Friedman, D. S. Berman, P. J. Slomka, Quantitative upright–supine high-speed SPECT myocardial perfusion imaging for detection of coronary artery disease: correlation with invasive coronary angiography, J. Nucl. Med. 51 (2010) 1724–1731.
[25]
D. S. Berman, X. Kang, B. Tamarappoo, A. Wolak, S. W. Hayes, R. Nakazato, L. E. J. Thomson, F. Kite, I. Cohen, P. J. Slomka, Stress thallium-201/rest technetium-99m sequential dual isotope high-speed myocardial perfusion imaging, JACC Cardiovasc. Imaging. 2 (2009) 273–282.
[26]
D. S. Berman, H. Kiat, J. D. Friedman, F. P. Wang, K. Van Train, L. Matzer, J. Maddahi, G. Germano, Separate acquisition rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: a clinical validation study, J. Am. Coll. Cardiol. 22 (1993) 1455–1464.
[27]
R. Hachamovitch, S. W. Hayes, J. D. Friedman, I. Cohen, D. S. Berman, Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography, Circulation. 107 (2003) 2900–2907.
[28]
C. Hernández, J. Candell-Riera, A. Ciudin, G. Francisco, S. Aguadé-Bruix, R. Simó, Prevalence and risk factors accounting for true silent myocardial ischemia: a pilot case-control study comparing type 2 diabetic with non-diabetic control subjects, Cardiovasc. Diabetol. 10 (2011) 9.
[29]
F. J. T. Wackers, L. H. Young, S. E. Inzucchi, D. A. Chyun, J. A. Davey, E. J. Barrett, R. Taillefer, S. D. Wittlin, G. V Heller, N. Filipchuk, Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects., Diabetes Care. 27 (2004).
[30]
K. Ohtomo, T. Shigeeda, A. Hirose, T. Ohno, O. Kinoshita, H. Fujita, J. Ando, R. Nagai, S. Takamoto, T. Kadowaki, Silent myocardial ischaemia in patients with diabetic retinopathy, Acta Ophthalmol. 92 (2014) e492–e493.
[31]
M. Araz, Z. Celen, I. Akdemir, V. Okan, Frequency of silent myocardial ischemia in type 2 diabetic patients and the relation with poor glycemic control, Acta Diabetol. 41 (2004) 38–43.
[32]
W. T. O’Neal, K. E. Lee, E. Z. Soliman, R. Klein, B. E. K. Klein, Predictors of electrocardiographic abnormalities in type 1 diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy, J. Endocrinol. Invest. 40 (2017) 313–318.
[33]
G. Al-Humaidi, I. Sarikaya, A. H. Elgazzar, A. Owunwanne, Myocardial perfusion abnormalities in asymptomatic type 2 diabetic patients, J. Saudi Hear. Assoc. 30 (2018) 3–8.
[34]
P. Valensi, A. Avignon, A. Sultan, B. Chanu, M. T. Nguyen, E. Cosson, Atherogenic dyslipidemia and risk of silent coronary artery disease in asymptomatic patients with type 2 diabetes: a cross-sectional study, Cardiovasc. Diabetol. 15 (2016) 104.
[35]
S. V. de Kreutzenberg, A. Solini, E. Vitolo, A. Boi, S. Bacci, S. Cocozza, R. Nappo, A. Rivellese, A. Avogaro, M. G. Baroni, Silent coronary heart disease in patients with type 2 diabetes: Application of a screening approach in a follow-up study, J. Diabetes Complications. 31 (2017) 952–957.
[36]
T. Um, D. H. Lee, J.-W. Kang, E. Y. Kim, Y. H. Yoon, The degree of diabetic retinopathy in patients with type 2 diabetes correlates with the presence and severity of coronary heart disease, J. Korean Med. Sci. 31 (2016) 1292–1299.
[37]
R. Cheloni, S. A. Gandolfi, C. Signorelli, A. Odone, Global prevalence of diabetic retinopathy: protocol for a systematic review and meta-analysis, BMJ Open. 9 (2019) e022188.
[38]
J. W. Y. Yau, S. L. Rogers, R. Kawasaki, E. L. Lamoureux, J. W. Kowalski, T. Bek, S.-J. Chen, J. M. Dekker, A. Fletcher, J. Grauslund, Global prevalence and major risk factors of diabetic retinopathy, Diabetes Care. 35 (2012) 556–564.
[39]
B. Zhou, Y. Lu, K. Hajifathalian, J. Bentham, M. Di Cesare, G. Danaei, H. Bixby, M. J. Cowan, M. K. Ali, C. Taddei, Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4• 4 million participants, Lancet. 387 (2016) 1513–1530.
[40]
A. Juutilainen, S. Lehto, T. Rönnemaa, K. Pyörälä, M. Laakso, Retinopathy predicts cardiovascular mortality in type 2 diabetic men and women, Diabetes Care. 30 (2007) 292–299.
[41]
M. Rema, V. Mohan, R. Deepa, R. Ravikumar, Association of carotid intima-media thickness and arterial stiffness with diabetic retinopathy: the Chennai Urban Rural Epidemiology Study (CURES-2), Diabetes Care. 27 (2004) 1962–1967.
[42]
N. Cheung, T. Y. Wong, Diabetic retinopathy and systemic vascular complications, Prog. Retin. Eye Res. 27 (2008) 161–176.
[43]
S. Moir, L. Hanekom, Z. Y. Fang, B. Haluska, C. Wong, M. Burgess, T. H. Marwick, Relationship between myocardial perfusion and dysfunction in diabetic cardiomyopathy: a study of quantitative contrast echocardiography and strain rate imaging, Heart. 92 (2006) 1414–1419.
[44]
R. Klein, A. R. Sharrett, B. E. K. Klein, S. E. Moss, A. R. Folsom, T. Y. Wong, F. L. Brancati, L. D. Hubbard, D. Couper, A. Group, The association of atherosclerosis, vascular risk factors, and retinopathy in adults with diabetes: the atherosclerosis risk in communities study, Ophthalmology. 109 (2002) 1225–1234.
[45]
J. Rong, C.-Q. Yu, P. Yang, J. Chen, Association of retinopathy with coronary atherosclerosis determined by coronary 64-slice multidetector computed tomography angiography in type 2 diabetes, Diabetes Vasc. Dis. Res. 10 (2013) 161–168.
[46]
T. Y. Wong, C. M. G. Cheung, M. Larsen, S. Sharma, R. Simó, Diabetic retinopathy, Nat. Rev. Dis. Prim. 2 (2016) 16012. https://doi.org/10.1038/nrdp.2016.12.
[47]
L. D. Metz, M. Beattie, R. Hom, R. F. Redberg, D. Grady, K. E. Fleischmann, The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis, J. Am. Coll. Cardiol. 49 (2007) 227–237.
Browse journals by subject