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Hosseinzadeh E, Ghodsirad M, Alirezaie T, Arfenia M, Amoui M, Pirayesh E, Norouzi G, Khoshbakht S. Assessing the prevalence and predicting factors of an abnormal gated myocardial perfusion SPECT in asymptomatic patients with type 2 diabetes. Int J Cardiovasc Imaging 2021; 38:457-464. [PMID: 34482508 DOI: 10.1007/s10554-021-02400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
Considering the significant prevalence of silent myocardial ischemia and its related morbidity and mortality in asymptomatic type 2 diabetic patients, it is not well known whether early screening with MPI is cost-effective and predicting factors are not well elucidated. This was a cross-sectional study including 63 asymptomatic patients with type 2 diabetes mellitus (T2DM), with normal ECG and ejection fraction. Patients with any history of documented valvular, congestive or ischemic heart disease, renal or hepatic failure were excluded. At first all patients were interviewed and checked for risk factors and then patients underwent a two-day rest/stress 99mTc-MIBI gated MPI SPECT. Data was assessed by QPS/QGS and 4DM software and evaluated by a nuclear medicine specialist with summed stress score (SSS) of more than 4 defined as CAD. There were 42 females (67%) and 21 males (33%), with a mean age of 61.33 ± 6.98 years and 7.97 ± 4.86 years history of T2DM. CAD was detected in 26 (41.3%) patients and was significantly associated with male gender, smoking and requiring insulin therapy (P-value = 0.019, 0.046, 0.05, respectively). A significant association was found between the duration of diabetes, especially when > 15 years, and the probability of having CAD. Multivariable logistic regression revealed that smoking; male gender and diabetes duration were the strongest independent predictors of abnormal MPI results. We found a high (46%) prevalence of abnormal stress MPI SPECT in patients with type 2 diabetes mellitus, despite being asymptomatic. Asymptomatic patients with a history of smoking, long duration of diabetes, being under insulin treatment and male gender might benefit from MPI for early detection of silent ischemia.
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Affiliation(s)
- E Hosseinzadeh
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadali Ghodsirad
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - T Alirezaie
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Cardiology Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Arfenia
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Amoui
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - E Pirayesh
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - G Norouzi
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Khoshbakht
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Predictors of abnormality in thallium myocardial perfusion scans for type 2 diabetes. Heart Vessels 2020; 36:180-188. [PMID: 32816060 DOI: 10.1007/s00380-020-01681-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/14/2020] [Indexed: 12/19/2022]
Abstract
Type 2 diabetes mellitus (T2DM) increases coronary artery disease (CAD) risk. In this study, we used T2DM clinical variables to predict abnormality in thallium-201 myocardial perfusion scans (Th-201 scans). These clinical variables were summed stress score (SSS), summed rest score, and summed difference score (SDS), with data obtained from 368 male and 428 female participants with T2DM. Multiple linear regression results were as follows. In male participants, body mass index (BMI) and creatinine (Cr) were associated with SSS (β = 0.224, p < 0.001; β = 0.140, p = 0.022, respectively), and only BMI was associated with SDS (β = 0.174, p = 0.004). In female participants, BMI and high-density lipoprotein cholesterol level were associated with SSS (β = 0.240, p < 0.001; β = - 0.120, p = 0.048, respectively), and only BMI was correlated with SDS (β = 0.123, p = 0.031). Our multivariate logistic regression indicated that in male and female participants, BMI was the only independent indicator of high SSS (SSS ≥ 9). In this study, we demonstrated that male patients have a higher SSS and SDS than female patients do in Th-201 scans for T2DM in a Chinese population. For male and female patients, BMI was the strongest predictor of abnormality in Th-201 scans. Our results can help clinicians identify patients with T2DM at high risk of CAD.
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Bourque JM, Beller GA. Value of Exercise ECG for Risk Stratification in Suspected or Known CAD in the Era of Advanced Imaging Technologies. JACC Cardiovasc Imaging 2016; 8:1309-21. [PMID: 26563861 DOI: 10.1016/j.jcmg.2015.09.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/15/2015] [Accepted: 09/23/2015] [Indexed: 02/07/2023]
Abstract
Exercise stress electrocardiography (ExECG) is underutilized as the initial test modality in patients with interpretable electrocardiograms who are able to exercise. Although stress myocardial imaging techniques provide valuable diagnostic and prognostic information, variables derived from ExECG can yield substantial data for risk stratification, either supplementary to imaging variables or without concurrent imaging. In addition to exercise-induced ischemic ST-segment depression, such markers as ST-segment elevation in lead aVR, abnormal heart rate recovery post-exercise, failure to achieve target heart rate, and poor exercise capacity improve risk stratification of ExECG. For example, patients achieving ≥10 metabolic equivalents on ExECG have a very low prevalence of inducible ischemia and an excellent prognosis. In contrast, cardiac imaging techniques add diagnostic and prognostic value in higher-risk populations (e.g., poor functional capacity, diabetes, or chronic kidney disease). Optimal test selection for symptomatic patients with suspected coronary artery disease requires a patient-centered approach factoring in the risk/benefit ratio and cost-effectiveness.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology, University of Virginia Health System, Charlottesville, Virginia.
| | - George A Beller
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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Bourque JM, Patel CA, Ali MM, Perez M, Watson DD, Beller GA. Prevalence and predictors of ischemia and outcomes in outpatients with diabetes mellitus referred for single-photon emission computed tomography myocardial perfusion imaging. Circ Cardiovasc Imaging 2013; 6:466-77. [PMID: 23547172 DOI: 10.1161/circimaging.112.000259] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background- The prevalence of ischemia and its prediction of events are unclear in outpatients with diabetes mellitus in the modern era of intensive medical management. We sought to identify the prevalence of ischemia, subsequent cardiac events, and impact of sex, stress type, and symptom status on these findings in a cohort of stable outpatients with diabetes mellitus referred for single-photon emission computed tomography myocardial perfusion imaging (MPI). Methods and Results- The study cohort included 575 consecutive outpatients with diabetes mellitus who underwent quantitative, gated single-photon emission computed tomography MPI. Clinical information, stress MPI variables, and cardiac events were prospectively collected and analyzed. The study population was at intermediate risk of coronary artery disease or had known coronary artery disease (40.3%); 29% of patients were asymptomatic at the time of stress testing. Scintigraphic ischemia and significant (≥10%) left ventricular ischemia were present in 126 patients (21.9%) and 29 patients (5.0%), respectively, and <1% of patients had early revascularization. The risk of ischemia was increased >2-fold by male sex (P<0.001), but was not impacted by pharmacological stress (P=0.15) or presence of symptoms (P=0.89). During a median 4.4 years follow-up, the rate of cardiac death/nonfatal myocardial infarction was moderate at 2.6%/y (cardiac death 0.8%/y) in the total cohort, but was 5.7%/y in those with ischemia (P<0.001). Pharmacological stress predicted a higher cardiac event rate (P<0.001) but symptoms did not (P=0.55). Conclusions- This cohort of stable outpatients with diabetes mellitus referred for single-photon emission computed tomography had low rates of significant ischemia and early revascularization; an initially low cardiac event rate increased after 2 years. Independent predictors of cardiac death/nonfatal myocardial infarction were known coronary artery disease, pharmacological stress, and MPI ischemia. Nearly one third of those with events had a normal MPI, indicating a need for improved risk stratification.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, Department of Radiology, University of Virginia Health System, Charlottesville, VA; and Cardiovascular Division, Department of Internal Medicine, Medical University of South Carolina, Charleston, SC
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Wiersma JJ, van der Zee PM, van Straalen JP, Fischer JC, van Eck-Smit BL, Tijssen JG, Trip MD, Piek JJ, Verberne HJ. NT-pro-BNP is associated with inducible myocardial ischemia in mildly symptomatic type 2 diabetic patients. Int J Cardiol 2010; 145:295-296. [DOI: 10.1016/j.ijcard.2009.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 10/17/2009] [Indexed: 11/26/2022]
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