The Assosiation of Carotid Intima-Media Thickness and Ankle Brachial Index with SPECT Myocardial Perfusion Imaging in Asymptomatic Diabetic Patients (original) (raw)
Related papers
Detection of myocardial ischemia in diabetic patients: the
2012
In the study of 286 patients with suspected coronary artery disease and recent exercise single photon emission computed tomography (SPECT) test, we performed coronary angiography with coronary fractional flow reserve (FFR) measurement and tested the differences between diabetic (103) and non-diabetic (183) patients in ischemia detection by this two methods. The diabetic patients had a higher prevalence of hypertension, higher BMI and cholesterol levels, as well as longer duration of hospitalization than non-diabetic patients. There was no difference found between groups according to the exercise SPECT test, but, there were significantly more negative results in the non-diabetic group than in the diabetic group according to the FFR test, also, the percentage of stenosis was higher in diabetic patients. The concordance between the two methods was found, it was fair in diabetic patients (kappa = 0.25, 95% C.I. 0.06-0.45) and moderate in non-diabetic patients (kappa = 0.49, 95% C.I. 0.36-0.62).
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..
A B S T R A C T In the study of 286 patients with suspected coronary artery disease and recent exercise single photon emission computed tomography (SPECT) test, we performed coronary angiography with coronary fractional flow reserve (FFR) measurement and tested the differences between diabetic (103) and non-diabetic (183) patients in ischemia detection by this two methods. The diabetic patients had a higher prevalence of hypertension, higher BMI and cholesterol levels, as well as longer duration of hospitalization than non-diabetic patients. There was no difference found between groups according to the exercise SPECT test, but, there were significantly more negative results in the non-diabetic group than in the diabetic group according to the FFR test, also, the percentage of stenosis was higher in diabetic patients. The concordance between the two methods was found, it was fair in diabetic patients (k=0.25, 95% C.I. 0.06–0.45) and moderate in non-diabetic patients (k=0.49, 95 % C.I. 0.36–0.62).
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...
The predictors of scintigraphic ischemia were studied in 169 Egyptian diabetic patients. They underwent stress-rest gated-SPECT myocardial perfusion imaging (MPI) protocol; also 25 subjects (control group) underwent Rest-Redistribution MPI protocol. The patients were followed up to 24 months. Results: We found significant relation between Summed stress score (SSS) and sudden cardiac death, MI and HF. Also there were statistically significant relation between atypical pain and HF. We found significant relation between summed rest scores (SRS) and sudden cardiac death, MI, HF, and stroke with p<0.001, p<0.038, p<0.001 and p<0.016 respectively. On applying univariate, multivariate analysis and Kaplan Meier survival for prognostic variables for MI, we found degree of typical pain (CCS class) is the most prognostic with HR=6.100, followed by TID of LV, lung uptake and SSS with HR=1.401, HR=1.115, and HR=1.100 respectively. Also we found that transient ischemic dilation (TID) of LV is the most prognostic variable for sudden cardiac death with HR=5.077, followed by SSS, SRS, degree of pain (Canadian Cardiovascular Society classification of chest pain (CCS) class), with HR=2.682, HR=2.636, HR=2.008, respectively. Conclusion: Semi-quantitative parameters such as SSS, SRS, SDS and percentage of ischaemic myocardium are independent predictors of MACE in both symptomatic and asymptomatic diabetic Egyptian patients, also In our cohort of diabetic patients we found high ischaemic burden, 39.2% of patients who had >10% ischaemic myocardium.
The Open Cardiovascular Medicine Journal, 2013
Background: Indonesia has the fourth largest number of diabetes patients after India, China and the USA. Coronary artery disease (CAD) is the most common cause of death in diabetic patients. Early detection and risk stratification is important for optimal management. Abnormal myocardial perfusion imaging (MPI) is an early manifestation in the ischemic cascade. Previous studies have demonstrated the use of MPI to accurately diagnose obstructive CAD and predict adverse cardiac events. This study evaluated whether MPI predicts adverse cardiac event in an Indonesian diabetic population.
Diabetes Care, 2009
OBJECTIVE Identification of asymptomatic patients with type 2 diabetes at increased risk for coronary artery disease (CAD) remains a challenge. We evaluated the potential of carotid intima-media thickness (CIMT) for prediction of abnormal myocardial perfusion in this population. RESEARCH DESIGN AND METHODS CIMT and SPECT myocardial perfusion imaging were assessed in 98 asymptomatic patients with type 2 diabetes. An increased CIMT was defined as ≥75th percentile of reference values. RESULTS Increased CIMT was an independent predictor of the extent of abnormal perfusion (P < 0.001). In patients with increased CIMT as compared with patients with normal CIMT, abnormal perfusion (75 vs. 9%) and severely abnormal perfusion (28 vs. 3%) were observed more frequently. CONCLUSIONS Increased CIMT was significantly related to the presence and extent of abnormal myocardial perfusion. Assessment of CIMT may be useful to identify asymptomatic patients with type 2 diabetes at higher risk for CAD.