Review article
Modern non-invasive coronary diagnosis in patients with diabetes mellitus

Patients with diabetes mellitus have high risk of complications like macroangiopathy. The clinical and angiographical view of atherosclerosis of coronary arteries is different by patients with and without diabetes. Silent ischemia and low exercise tolerance are equivalents of advanced coronary artery disease in diabetics. Efficient non-invasive diagnosis of atherosclerosis of coronary arteries is one of the main aims of cardiology. Very often diabetics are not able to perform the diagnostic exercise test or the clinical interpretation of this test is very difficult. Echocardiographical tests with dobutamine or dipirydamol are marked with a big percentage of false positive results. Those results are caused by metabolic disorders and structural changes of cardiomyocytes due to microangiopathy . Perfusion scintigraphy investigation is very expensive, partly invasive (application of radioisotope, radiation) and available in a few hospitals. Its usefulness is observed in case of evaluation of vitality of myocardium, especially in patients after silent infarct. There are hopes associated with modern coronary diagnostics like computer tomography or magnetic resonance, which give us possibility to observe in non-invasive way the atheromatous plaque. Including the character of atherosclerosis in diabetics, score of calcification of arteries may be clinically very useful. However the exercise test with assessment of respiratory gas exchange is very objective examination of exact exercise tolerance, life quality and review of treatment effects in diabetics.