Progressive CAD remains asymptomatic in many cases of type II diabetes mellitus (DM) and this makes diagnosis difficult
at proper time. Routine screening of type II DM for silent ischemia with ECG remains controversial as majority of patients
present with normal ECG. We are presenting a study focused on early detection of silent ischemia in type II DM patients among
rural population of Central India by using TMT; where modalities such as coronary angiography and MDCT are not readily
available and finance is a major issue. We also aimed at predicting risk factors for silent ischemia in this cohort. 161 DM patients
with normal baseline ECG were screened by TMT using BPL Dynatrac software ver 3.8. 34 of 161 patients were positive for
inducible ischemia. Of these, 27 underwent exercise stress echo immediately after TMT and presence of RWMA was confirmed
in 20 patients. All TMT positive patients were advised to undergo coronary angiography. In present study, age, duration of DM,
TC, TGs, TC/HDL ratio, poor glycemic control, diabetic retinopathy and nephropathy were the key predictors of silent ischemia
and association of diabetic nephropathy is sensationally high with silent ischemia. In conclusion, although the study population
was of low socioeconomic group with moderate to heavy working life style, the prevalence of silent ischemia and risk factors
remained more or less similar to that of urban population and TMT emerged out as an effective screening tool for detection of
silent ischemia in this cohort.
A. S. Lavekar is a post-graduate student of medicine. H. R. Salkar, is Ex-Professor & Head, GMC Nagpur and presently Professor & Head at NKP SIMS, Nagpur. She has published around 25 papers in journals of repute and is a member of international advisory board of ?Davidson?s Principles and Practice of Medicine?. A.S. Modak is Ex-Associate Professor at GMC Nagpur and presently working as Associate Professor at NKP SIMS, Nagpur and has done pioneering work in the field of echo-cardiology in Central India.
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