Impact of Diabetes on the Risk Stratification Using Stress Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging in Patients With Symptoms Suggestive of Coronary Artery Disease

Abstract

Background-Coronary artery disease can develop prematurely and is the leading cause of death among diabetics, making noninvasive risk stratification desirable. Methods and Results-Patients with symptoms of coronary artery disease who were undergoing stress myocardial perfusion imaging (MPI) from 5 centers were prospectively followed (2.5Ϯ1.5 years) for the subsequent occurrence of cardiac death, myocardial infarction (MI), and revascularization. Stress MPI results were categorized as normal or abnormal (fixed or ischemic defects and 1, 2, or 3 vessel distribution

Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

“…[30] Another study demonstrated that 8.6% of patients with diabetes had cardiac events (cardiac deaths and myocardial infarction) compared with 4.5% in the nondiabetic cohort. [12] The critical event rate seemed lower in our study as long as one-year interim results were observed. Even in our study, however, the incidence of sudden death, PCI, CABG, severe heart failure was in 3.6% of asymptomatic patients and cerebrovascular accident and transient ischemic attack in 1.4%.…”

“…SPECT imaging was performed with standard acquisition protocols with 360 or 180-degree rotations. Gating was performed by 16,8,12 and 32 frames per cardiac cycle in 44%, 40%, 12% and 4% of the institutions. According to the preceding J-ACCESS substudy in patients with low-likelihood of ischemic heart disease and no events, EF with the 16-frame study was significantly higher than that with the 8-frame study by 4% only in men.…”

“…[7][8][9] The role of MPI for detecting ischemia has been validated well and supported by many precedent single-photon emission computed tomography (SPECT) studies. [10][11][12][13] A general consensus has been achieved for detection of ischemia and prognostic evaluation. [3,14] Although abundant data are available in Western countries, few data are available dealing with the role of MPI in Japanese non-diabetic and diabetic patients.…”

Guidelines on myocardial revascularization

“…Newer SPECT techniques with ECG gating improve diagnostic accuracy in various patient populations, including women, diabetics, and elderly patients [23]. Adding information from a simultaneously performed calcium score using MDCT may further increase the accuracy [24].…”

The epidemics of obesity and type 2 diabetes: implications for noninvasive cardiovascular imaging

“…3 Myocardial perfusion imaging variables provide major incremental value for risk stratification in diabetic persons. 4 In this study diabetic women with ischemia in two or more coronary vascular territories had only a 60% 3-year survival free of cardiac death or nonfatal infarction. Diabetic men had a 79% event-free survival rate.…”