Predictive Value of Differential Pulse Pressure in the Diagnosis of Silent Myocardial Ischemia in Patients With Type-2 Diabetes

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.

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.