After ref. 27.

test. The diagnostic value of magnetic resonance tomography angiography is currently under evaluation. Unfortunately, the best approach is still to study the patient directly with coronary angiography if there is a suspicion of coronary heart disease: LV dilatation on echocardiography, regional contraction abnormalities on echocardiography, sudden deterioration of cardiac function with pulmonary edema, and arrhythmia or an increase in troponin T concentration. Troponin T is excreted via the kidney and it has long been controversial whether it is a faithful predictor of myocardial ischemia in the presence of renal failure, but this issue has recently been settled (34). In the renal patient, troponin T concentrations are predictive of cardiac death (35) even in the absence of overt coronary heart disease, presumably reflecting diffuse myocardial microvascular ischemia. Nevertheless, an acute major increase is a reliable indicator of MI in the uremic diabetic patient as well (Table 3).

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