Prevalence and prognosis of unrecognized myocardial infarction in asymptomatic patients with diabetes: A two-center study with up to 5 years of follow-up

Michael D. Elliott*, John F. Heitner, Han Kim, Edwin Wu, Michele A. Parker, Daniel C Lee, Dixon B. Kaufman, Robert O Bonow, Robert Judd, Raymond J. Kim

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE To determine the prevalence and prognostic significance of unrecognized myocardial infarction (MI) by delayed-enhancement MRI (DE-MRI) in asymptomatic patients with diabetes. RESEARCH DESIGN AND METHODS In this prospective, two-center study of asymptomatic patients without known cardiac disease (n = 120), two prespecified cohorts underwent a research MRI: 1) a high-risk group with type 1 diabetes and chronic renal insufficiency (n = 50) and 2) an average-risk group with type 2 diabetes (n = 70). The primary end point was a composite of all-cause mortality and clinical MI. RESULTS Overall, the prevalence of unrecognizedMIwas 19%by DE-MRI (28% high-risk group and 13% average-risk group) and 5% by electrocardiography. During up to 5 years of follow-up with a total of 460 patient-years of follow-up, the rate of death/MI was markedly higher in patients with diabetes with (vs. without) unrecognized MI (all 44% vs. 7%, high-risk group 43% vs. 6%, and average-risk group 44% vs. 8%; all P < 0.01). After adjustment for Framingham risk score, left ventricular ejection fraction, and diabetes type, the presence of unrecognized MI by DE-MRI conferred an eightfold increase in risk of death/MI (95% CI 3.0-21.1, P < 0.0001). Addition of unrecognized MI to clinical indices significantly improved model discrimination for adverse events (integrated discrimination improvement = 0.156, P = 0.001). CONCLUSIONS Unrecognized MI is prevalent in asymptomatic patients with diabetes without a history of cardiac disease and confers a markedly increased risk of death and clinical MI.

Original languageEnglish (US)
Pages (from-to)1290-1296
Number of pages7
JournalDiabetes care
Volume42
Issue number7
DOIs
StatePublished - Jan 1 2019

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Myocardial Infarction
Heart Diseases
Risk Adjustment
Mortality
Type 1 Diabetes Mellitus
Chronic Renal Insufficiency
Stroke Volume
Type 2 Diabetes Mellitus
Electrocardiography
Research

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Elliott, Michael D. ; Heitner, John F. ; Kim, Han ; Wu, Edwin ; Parker, Michele A. ; Lee, Daniel C ; Kaufman, Dixon B. ; Bonow, Robert O ; Judd, Robert ; Kim, Raymond J. / Prevalence and prognosis of unrecognized myocardial infarction in asymptomatic patients with diabetes : A two-center study with up to 5 years of follow-up. In: Diabetes care. 2019 ; Vol. 42, No. 7. pp. 1290-1296.
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title = "Prevalence and prognosis of unrecognized myocardial infarction in asymptomatic patients with diabetes: A two-center study with up to 5 years of follow-up",
abstract = "OBJECTIVE To determine the prevalence and prognostic significance of unrecognized myocardial infarction (MI) by delayed-enhancement MRI (DE-MRI) in asymptomatic patients with diabetes. RESEARCH DESIGN AND METHODS In this prospective, two-center study of asymptomatic patients without known cardiac disease (n = 120), two prespecified cohorts underwent a research MRI: 1) a high-risk group with type 1 diabetes and chronic renal insufficiency (n = 50) and 2) an average-risk group with type 2 diabetes (n = 70). The primary end point was a composite of all-cause mortality and clinical MI. RESULTS Overall, the prevalence of unrecognizedMIwas 19{\%}by DE-MRI (28{\%} high-risk group and 13{\%} average-risk group) and 5{\%} by electrocardiography. During up to 5 years of follow-up with a total of 460 patient-years of follow-up, the rate of death/MI was markedly higher in patients with diabetes with (vs. without) unrecognized MI (all 44{\%} vs. 7{\%}, high-risk group 43{\%} vs. 6{\%}, and average-risk group 44{\%} vs. 8{\%}; all P < 0.01). After adjustment for Framingham risk score, left ventricular ejection fraction, and diabetes type, the presence of unrecognized MI by DE-MRI conferred an eightfold increase in risk of death/MI (95{\%} CI 3.0-21.1, P < 0.0001). Addition of unrecognized MI to clinical indices significantly improved model discrimination for adverse events (integrated discrimination improvement = 0.156, P = 0.001). CONCLUSIONS Unrecognized MI is prevalent in asymptomatic patients with diabetes without a history of cardiac disease and confers a markedly increased risk of death and clinical MI.",
author = "Elliott, {Michael D.} and Heitner, {John F.} and Han Kim and Edwin Wu and Parker, {Michele A.} and Lee, {Daniel C} and Kaufman, {Dixon B.} and Bonow, {Robert O} and Robert Judd and Kim, {Raymond J.}",
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doi = "10.2337/dc18-2266",
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pages = "1290--1296",
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Prevalence and prognosis of unrecognized myocardial infarction in asymptomatic patients with diabetes : A two-center study with up to 5 years of follow-up. / Elliott, Michael D.; Heitner, John F.; Kim, Han; Wu, Edwin; Parker, Michele A.; Lee, Daniel C; Kaufman, Dixon B.; Bonow, Robert O; Judd, Robert; Kim, Raymond J.

In: Diabetes care, Vol. 42, No. 7, 01.01.2019, p. 1290-1296.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prevalence and prognosis of unrecognized myocardial infarction in asymptomatic patients with diabetes

T2 - A two-center study with up to 5 years of follow-up

AU - Elliott, Michael D.

AU - Heitner, John F.

AU - Kim, Han

AU - Wu, Edwin

AU - Parker, Michele A.

AU - Lee, Daniel C

AU - Kaufman, Dixon B.

AU - Bonow, Robert O

AU - Judd, Robert

AU - Kim, Raymond J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVE To determine the prevalence and prognostic significance of unrecognized myocardial infarction (MI) by delayed-enhancement MRI (DE-MRI) in asymptomatic patients with diabetes. RESEARCH DESIGN AND METHODS In this prospective, two-center study of asymptomatic patients without known cardiac disease (n = 120), two prespecified cohorts underwent a research MRI: 1) a high-risk group with type 1 diabetes and chronic renal insufficiency (n = 50) and 2) an average-risk group with type 2 diabetes (n = 70). The primary end point was a composite of all-cause mortality and clinical MI. RESULTS Overall, the prevalence of unrecognizedMIwas 19%by DE-MRI (28% high-risk group and 13% average-risk group) and 5% by electrocardiography. During up to 5 years of follow-up with a total of 460 patient-years of follow-up, the rate of death/MI was markedly higher in patients with diabetes with (vs. without) unrecognized MI (all 44% vs. 7%, high-risk group 43% vs. 6%, and average-risk group 44% vs. 8%; all P < 0.01). After adjustment for Framingham risk score, left ventricular ejection fraction, and diabetes type, the presence of unrecognized MI by DE-MRI conferred an eightfold increase in risk of death/MI (95% CI 3.0-21.1, P < 0.0001). Addition of unrecognized MI to clinical indices significantly improved model discrimination for adverse events (integrated discrimination improvement = 0.156, P = 0.001). CONCLUSIONS Unrecognized MI is prevalent in asymptomatic patients with diabetes without a history of cardiac disease and confers a markedly increased risk of death and clinical MI.

AB - OBJECTIVE To determine the prevalence and prognostic significance of unrecognized myocardial infarction (MI) by delayed-enhancement MRI (DE-MRI) in asymptomatic patients with diabetes. RESEARCH DESIGN AND METHODS In this prospective, two-center study of asymptomatic patients without known cardiac disease (n = 120), two prespecified cohorts underwent a research MRI: 1) a high-risk group with type 1 diabetes and chronic renal insufficiency (n = 50) and 2) an average-risk group with type 2 diabetes (n = 70). The primary end point was a composite of all-cause mortality and clinical MI. RESULTS Overall, the prevalence of unrecognizedMIwas 19%by DE-MRI (28% high-risk group and 13% average-risk group) and 5% by electrocardiography. During up to 5 years of follow-up with a total of 460 patient-years of follow-up, the rate of death/MI was markedly higher in patients with diabetes with (vs. without) unrecognized MI (all 44% vs. 7%, high-risk group 43% vs. 6%, and average-risk group 44% vs. 8%; all P < 0.01). After adjustment for Framingham risk score, left ventricular ejection fraction, and diabetes type, the presence of unrecognized MI by DE-MRI conferred an eightfold increase in risk of death/MI (95% CI 3.0-21.1, P < 0.0001). Addition of unrecognized MI to clinical indices significantly improved model discrimination for adverse events (integrated discrimination improvement = 0.156, P = 0.001). CONCLUSIONS Unrecognized MI is prevalent in asymptomatic patients with diabetes without a history of cardiac disease and confers a markedly increased risk of death and clinical MI.

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