Role of Hs-CRP and Exercise Stress Echocardiography in Cardiovascular Risk Stratification of Asymptomatic Type 2 Diabetic Patients

Background: Silent ischaemia is a well known cause of mortality and morbidity in type-2 diabetic patients; however the role of high-sensitive C-Reactive Protein (hs-CRP) and exercise stress echocardiography in early detection of silent ischaemia is still less understood.

Methods: Seventy three asymptomatic diabetic patients were enrolled from Dr Ram Manohar Lohia Hospital, Delhi in year 2013-15 and the baseline characteristics of the patients were studied. All the patients underwent exercise stress echocardiography for screening of coronary artery disease (CAD). All the patients with positive exercise stress echocardiography underwent angiography for confirmation of coronary artery disease. The patients were divided into two groups on basis of exercise stress echocardiography result as positive and negative and the baseline characteristics and risk factors including high-sensitivity C-reactive protein (hs-CRP) concentrations were compared between two groups in cross sectional study.

Results: Silent ischaemia was found in 17.81% in asymptomatic diabetic patients. The positive predictive value of exercise stress echocardiography taking angiography as gold standard was found to be 84.6%. Sensitivity of hs-CRP >3 mg/L in predicting a positive exercise stress echocardiography is 53.8% and specificity is 90%. Negative predictive value of hs-CRP ≤3 mg/L in ruling out CAD is 90.0% and positive predictive value in detecting positive exercise stress echocardiography was 53.8%. Positive exercise stress echocardiography was found to be significantly associated with hypertension (HTN) (P=0.048), smoking (P=0.018), family history of CAD (P=0.002), total cholesterol (P=0.031), serum low-density lipoprotein (LDL) concentrations (P=0.041), serum hs-CRP (P=0.001), strict glycaemic control (glycated haemoglobin <7%) (P=0.028) and final ejection fraction after exercise stress (P=0.01).

Conclusion: hs-CRP and exercise stress echocardiography can be used as simple screening tool for coronary artery disease in asymptomatic diabetic patients.