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[Clinical and diagnostic aspects of coronary disease in diabetic patients].

Coronary heart disease in diabetic patients is more frequent than in non-diabetic patients, even without other associated risk factors. It is generally characterised by multi-vessel and distal lesions, associated with an increase incidence of moderate diffuse stenoses, endothelial dysfunction and intramyocardial microangiopathy. Diabetic patients present with a higher incidence of silent myocardial ischaemia (around 30%) than non-diabetic patients. The diagnosis of coronary artery disease has to be assessed mainly using non invasive techniques, particularly cardiac imaging with sensitising tests: thallium myocardial scintigraphy, echocardiography using exercise stress test or pharmacologically-induced stress (dipyridanole, dobutamide). The characteristics of these methods and their predictive values are described, and a step-by-step diagnosis approach is proposed.