Noninvasive Diagnosis of Coronary Artery Disease in Patients With Diabetes by Dobutamine Stress Real-Time Myocardial Contrast Perfusion Imaging

Abstract

OBJECTIVE -The aim of this study was to assess the accuracy of real-time myocardial contrast perfusion imaging (MCPI) during dobutamine stress in the diagnosis and localization of coronary artery disease (CAD) in patients with diabetes. Myocardial contrast echocardiography is a new technique that allows evaluation of myocardial perfusion. Its utility in diabetic patients has not been defined. RESEARCH DESIGN AND METHODS-Dobutamine-atropine stress test was performed in conjunction with MCPI using Optison or Definity at rest and at peak stress in 128 patients with diabetes and suspected CAD who underwent coronary angiography within 1 month. CAD was defined as Ն50% stenosis in one or more coronary artery. MCPI was considered diagnostic of CAD in the presence of reversible perfusion abnormalities. The normalcy rate of MCPI was additionally determined in 18 asymptomatic nondiabetic patients with low probability.RESULTS -CAD was detected in 101 (79%) patients by angiography. Reversible perfusion abnormalities were detected in 90 patients with and 13 patients without CAD. The overall sensitivity of MCPI was 89% (95% CI 83-95), specificity 52% (33-71), and accuracy 81% (75-88). Reversible abnormalities were detected in two or more vascular distributions in 44 of 56 patients with multivessel CAD and in 8 of 63 patients without (sensitivity 68%, specificity 87%, positive predictive value 84%, and accuracy 79%). Regional sensitivity was 75% (65-85) for left anterior descending CAD, 71% (60 -83) for left circumflex, and 67% (55-78) for right CAD. MCPI was normal in 16 of the 18 patients with low clinical probability of CAD (normalcy rate 89%).CONCLUSIONS -MCPI is a useful noninvasive technique for the diagnosis and localization of CAD in diabetic patients. The extent of perfusion abnormalities can identify patients with multivessel CAD with a moderate sensitivity and high specificity. Diabetes Care 28:1662-1667, 2005C oronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with diabetes (1-5). Among patients with CAD, diabetes is associated with a worse prognosis (6 -8). Angiographic studies have shown that patients with diabetes have more advanced CAD at the time of the diagnosis. Although coronary angiography remains the gold standard, the expense and risk associated with this procedure prohibit its routine use for diagnosis of CAD.Various noninvasive stress imaging modalities are currently available for the evaluation of CAD in diabetic patients (10 -23). However, there are scarce data regarding the ability of noninvasive imaging techniques to identify multivessel CAD based on abnormalities in multivascular regions. This information is important since the extent of CAD determines the outcome, as well as potential benefit, of revascularization (24,25). Dobutamine stress echocardiography (DSE) has been reported as a safe method for evaluation of CAD in diabetic patients (23). Nevertheless, there are limited data regarding the diagnostic accuracy of this technique. Previous studies included in...

Non-invasive assessment of coronary artery disease in diabetes

“…One study has specifically addressed the value of contrast echocardiography in the detection of CAD in patients with DM. Elhendy et al evaluated 128 patients with contrast echocardiography; in 101 (79%) patients, invasive angiography detected CAD 13. The sensitivity and specificity were 89% and 52%, respectively.…”

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Investigation of Serum Oxidized Low-Density Lipoprotein IgG Levels in Patients with Angiographically Defined Coronary Artery Disease

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