La
isquemia miocárdica silente es más frecuente en diabéticos. La
presión arterial diferencial del
pulso tiene valor como predictora de
riesgo de
enfermedad cardiovascular. Estudiamos a 48 varones diabéticos tipo 2 consecutivos sin antecedentes de
cardiopatía isquémica . Realizamos medición ambulatoria de la
presión arterial y un protocolo de estudio de
isquemia miocárdica silente que incluyó
ECG en
reposo , ecocardiograma, Holter-
ECG -24 h y
ergometría convencional y con
isótopos radiactivos . Nueve
pacientes (19%) presentaron
isquemia miocárdica silente. La
presión diferencial del
pulso mostró buena capacidad discriminadora para determinar la presencia de
isquemia silente (
área bajo la curva [COR] = 0,83; intervalo de
confianza [IC] del 95%, 0,71-0,96; p = 0,002). El efecto predictor se mantuvo en el modelo de
regresión logística ajustado (
odds ratio [OR] = 1,24; IC del 95%, 1,02-1,49). Estimamos una OR de 8,5 (IC del 95%, 1,7-31,2) por cada incremento de 10 mmHg de la
presión diferencial del
pulso para el
riesgo de presentar
isquemia silente. La edad y la
presión diferencial del
pulso fueron los únicos predictores independientes de
isquemia miocárdica silente encontrados en este estudio (AU)
Silent
myocardial ischemia occurs more frequently in diabetics. Differential arterial
pulse pressure is a valuable predictor of
cardiovascular disease . We studied 48 consecutive
male patients with type-2 diabetes and no known
history of
ischemic heart disease .
Ambulatory monitoring of
arterial pressure was carried out and the presence of silent
myocardial ischemia was studied using a protocol that involved resting
ECG ,
echocardiography , 24-hour
Holter ECG , conventional
exercise stress testing, and exercise testing with nuclear scanning. Nine
patients (19%) had silent
myocardial ischemia . Differential
pulse pressure had good discriminative
ability in identifying the presence of silent
ischemia the area under the
receiver operating characteristic (ROC) curve was 0.83 (95%
confidence interval [CI], 0.71-0.96; P=.002). This predictive
ability was also observed on adjusted
logistic regression modeling (
odds ratio [OR], 1.24, 95% CI = 1.02-1.49). We found that the OR for the
risk of silent
ischemia for every 10-mmHg increase in differential
pulse pressure was 8.5 (95% CI 1.7-31.2). Age and differential
pulse pressure were the only independent predictors of silent
myocardial ischemia found in this study (AU)