Increased Carotid Intima-Media Thickness as a Predictor of the Presence and Extent of Abnormal Myocardial Perfusion in Type 2 Diabetes (original) (raw)
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Iranian Journal of Diabetes and Obesity, 2015
iabetes mellitus (DM) is an independent risk factor of cardiovascular disease (CAD) (1-3). CAD is the leading cause of death in DM patients (4). Myocardial infarction (MI), Angina and sudden death rates in diabetic patients are higher than normal population (5). D 1. MD, Shahid Sadoughi University of Medical Sciences Yazd, Iran. 2. MD, Assistant Professor of Nuclear Medicine, Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 3. MD, Cardiologist, Afshar Hospital, Shahid Sadoughi University of Medical Sciences Yazd, Iran. 4. DDH, Assistant Professor of Maxilo Facial Radiology Dental Factuly Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 5. Nuclear Medicine Specialist, Department of Radiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 6. MD, Assistant Professor Community Medicine. Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 7. MD, Department of Cardiology, Afshar ...
Srpski arhiv za celokupno lekarstvo, 2021
Introduction/Objective. Myocardial perfusion imaging (MPI) is clinically useful for the evaluation of coronary artery disease in patients with diabetes mellitus. However, the prevalence of ischemia and its ability to predict future cardiac events is less clear. The aim was to determine the incidence of cardiac events in diabetic patients and the relationship between them and MPI findings. Methods. Two cohorts of patients, 98 diabetics and 100 non-diabetics, with medium- to high-risk of coronary artery disease without previous coronary revascularization, were studied prospectively. All of them were outpatients who underwent 99mTc-sestamibi MPI with dipyridamole. The data about cardiac events were collected during a follow-up period of two years. Results. Cardiac events occurred in 17.3% diabetics and in 8% non-diabetics (p = 0.048). Diabetics had shorter estimated event-free time of 24.7 months (95% CI 23.2?26.2) versus non-diabetics? estimated event-free time of 28.5 months (95% CI ...
The Role of Myocardial Perfusion Imaging in Patients with Diabetes Mellitus
Internal Medicine, 2021
Diabetes mellitus is a complex pathology with increasing incidence, associated with an increased risk of coronary heart disease. Myocardial perfusion imaging (MPI) is an important diagnostic tool for the evaluation of coronary artery disease (CAD), with a high prognostic value. Objective. The aim of this study was to evaluate the role of stress-rest MPI in the assessment of patients with DM and suspected or confirmed CAD. Method. We performed a retrospective analysis of 128 patients who underwent stress-rest MPI in our department, all of them with coronary angiography (CA) available. All patients underwent stress rest myocardial perfusion SPECT using a 1-day or 2-day protocol. The radiopharmaceuticals used were 99m-Tc-MIBI or tetrofosmin. The study was performed with a gated protocol SPECT, synchronous with the ECG, using a dual-head gamma camera. Patients were divided in 4 subgroups based on the presence of DM and of significant CA changes. Results. In the group of patients with si...
European Journal of Nuclear Medicine and Molecular Imaging, 2009
Purpose. Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. Methods. A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1mm, urinary albumin excretion of ≥30mg/ g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level and hypertension were enrolled and followed up over a3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Results. Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the one-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 allcause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0-3, 4-8, 9-13 and ≥14 were 0.96, 0.95, 0.82 and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident and electrocardiographic abnormality at rest. Conclusions. The one-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients.
Diabetes Care, 2010
OBJECTIVE Individuals with type 2 diabetes are at high risk for cardiovascular events. We evaluated the prognostic value of gated myocardial perfusion single-photon computed tomography (SPECT) for asymptomatic diabetic patients in a Japanese population. RESEARCH DESIGN AND METHODS Asymptomatic patients (n = 485) aged ≥50 years with either a maximal carotid artery intima-media thickness of ≥1.1 mm, or a urinary albumin ≥30 mg/g creatinine or who had at least two of the following, abdominal obesity, low HDL cholesterol, high triglyceride levels, and hypertension, were enrolled at 50 institutions. The patients were evaluated using gated SPECT with the stress-rest protocol and followed up for 3 years. RESULTS During the follow-up period, 62 (13%) events occurred, including 5 cardiac deaths and 57 cardiovascular events. Patients with summed stress scores (SSS) of ≥9 had a significantly higher incidence (of either death or cardiovascular events) than those with SSS scores of <9 (23 vs....
Nuclear Medicine Communications, 2005
Type 2 diabetes markedly increases cardiovascular risk, and patients often present with advanced and asymptomatic disease. The fact that diabetes is associated with an increased risk of acute coronary events and poor long-term survival makes a strong case for detecting coronary artery disease early, perhaps before clinical manifestation in this patient population. This article examines the role of myocardial perfusion scintigraphy in the diagnostic and prognostic evaluation of diabetic patients with suspected coronary artery disease and in screening high-risk asymptomatic diabetic patients.
2012
Background and Aim: Diabetes mellitus is a recognized risk factor for coronary artery disease (CAD). However ischemia in diabetics may express their ischemia as atypical symptoms. We aimed at comparing incidence and extent of diabetic vs. non diabetic with other risk factors for CAD. Patients: The study included 46 pts with 1 or 2 risk factors for CAD mean age 55+6 years, 18 males. Methods: Patients were subjected to laboratory assessment including lipid profile, HbA1C, microalbuminuria. Patients were subjected to myocardial perfusion imaging [(MPI) study using 2 day (stress-rest) protocol patients were injected 25 mCi Tc sestaMIBI intravenously at peak of stress. Rest study was acquired in a separate day. Gated SPECT was acquired 30-60 minute post-stress for estimation of LVEDV, LVESV and LVEF. Processing and analysis were done to get the classic short axis, vertical long axis and horizontal long axis slices with application of 20 segment scoring system for semiquantitative analysi...
Nuclear Medicine Review, 2017
BACKGROUND: The aim of the study was to evaluate whether there is any association between myocardial ischemia, common risk factors and carotid artery ultrasound parameters in asymptomatic type 2 diabetic (DMT2) patients. MATERIAL AND METHODS: 60 asymptomatic DMT2 patients (pts) without known coronary artery disease (CAD) underwent one day rest Dypiridamole stress Tc-99m sestamibi single photon emission computed tomography myocardial perfusion scintigraphy (MPS). We used 17 segment models for perfusion analysis with the assessment of perfusion scores. Patients were studied for age, sex, hypertension, hyperlipidemia, hs-CRP, smoking, obesity and family history of cardiac disease. Color Ultrasound examination of carotid arteries was performed in all patients. RESULTS: 51 patients (pts) had hypertension, 48 pts had hyperlipidemia, 15 were smokers, 6 pts had BMI > 30 kg/m 2 and 26 patients had positive family history for CAD. 18 (31%) patients had myocardial ischemia. Mild ischemia was found in 6 pts, moderate in 7 patients and severe ischemia in 5 patients. Carotid IMT was increased in 34 pts and 15 pts had carotid plaques. Mean c-IMT value in patients with normal MPS results was 0.7 ± 0.1; in moderate ischemia 0.9 ± 0.1 and in pts severe ischemia 1.0 ± 0.2. Multivariate analysis showed obesity, low HDL and increased diastolic blood pressure predictors of increased c-IMT. Increased pulse pressure (PP), age and non-HDL cholesterol were predictors for presence of carotid plaques. Multivariable analysis for prediction of stress induced ischemia showed OR 2.9 (95% CI 2.1−5.1) for male gender, OR 3.1 for systolic blood pressure (95% CI 1.9-3.8) and OR 2.8 for LDL cholesterol (95% CI 1.7−3.6). CONCLUSIONS: Our study has shown high prevalence of traditional risk factors and silent myocardial ischemia in type 2 diabetic patients, with the importance of SPECT imaging in selected diabetes type 2 patients. The study highlights the importance of screening for carotid atherosclerosis, which may be useful to identify diabetic patients at higher risk for coronary artery disease..