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Objective: This study investigates the efficacy of radionuclide myocardial perfusion imaging (MPI) in the evaluation of cardiac outcome in optimally treated diabetic patients without manifestations of coronary artery disease (CAD) in relation to the inherent clinical risk., Methods: Follow-up data were collected from 86 diabetic patients who had undergone adenosine stressing MPI. These patients either had no symptoms or had noncardiac chest discomfort, had a normal resting electrocardiogram, had no known CAD or prior positive stress test results, and were receiving currently recommended therapy. Endpoints were cardiac death, myocardial infarction, new-onset heart failure, and CAD diagnosed by angiography at least 2 months from the MPI, irrespective of subsequent revascularization., Results: Twenty-six (30%) diabetic patients had abnormal perfusion and the remaining had a normal scan. Over a median follow-up period of 32.5 months 14 cardiac events occurred. In patients with normal MPI, the annual cardiac event rate was 4.0% compared with 12.2% in those with abnormal MPI (P=0.008). In multivariate analysis, myocardial ischemia (hazard ratio 5.3; P=0.006), obesity (hazard ratio 6.8; P=0.005), the ALFEDIAM/SFC risk (hazard ratio 6.8; P=0.002), and type 2 diabetes (hazard ratio 5.3; P=0.035) were found to be independent predictors of cardiac events. The former two variables remained independent determinants of the outcome, together with peripheral arterial disease, when a different clinical risk classification system was applied. MPI provided incremental prognostic information over both clinical models formed., Conclusion: Adenosine MPI can effectively risk-stratify optimally treated diabetic patients without manifestations of CAD. In this subset, clinical variables can also determine the outcome independently, but MPI adds incremental predictability over them.

We investigated the relation between diabetic autonomic neuropathy (DAN) and left ventricular (LV) function in 59 patients with type 2 diabetes mellitus (T2DM) free of coronary artery disease (CAD) or hypertension. Diabetic autonomic neuropathy was established by ≥2 abnormal autonomic nervous function tests. Left ventricular systolic and diastolic functions were assessed by resting radionuclide ventriculography. Compared with non-DAN patients (n = 24), patients with DAN (n = 35) had an increased adjusted atrial contribution to ventricular filling (A/V%, 30.1% ± 8.2% vs 26.5% ± 5.1%; P = .031), suggestive of diastolic dysfunction (DD). There were no differences between the 2 groups in peak filling rate, first 1/3 filling fraction, ejection fraction, cardiac output, and cardiac index. Patients with diabetic autonomic neuropathy had an increased heart rate (77.8 ± 6.3 vs 69.3 ± 3.3 bpm; P < .0001) and a higher rest LV workload (10 072 ± 1165 vs 8606 ± 1075 bpm mm Hg; P < .0001). Patients with DAN T2DM without CAD or hypertension have DD, increased A/V index, and a higher LV working load than non-DAN patients. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: The aim of this study was to examine the interaction between cardiorespiratory capacity and cardiovascular risk factors in patients with Type 2 diabetes mellitus (T2DM). Research Design/Methods: A total of 92 patients with T2DM (40 men, 52 women) performed a symptom-limited exercise test on ergocycle, with continuous gas exchange measurement. All patients were overweight or obese (body mass index >25 kg/m2), with poor glycemic control (hemoglobin A1c >7%), but free from overt diabetic vascular complications. Anthropometric parameters, blood pressure (BP), cardiorespiratory fitness, glycemic and lipid profile, fibrinogen, plasminogen activator inhibitor-1, high-sensitivity C-reactive protein (hsCRP), insulin resistance, and 24-h urinary albumin excretion (UAE) were measured. Based on the median V̇o 2 peak value, participants were placed into low fitness (LF, n=46) or moderate fitness group (MF, n=46). Results: In univariate analysis, exercise capacity correlated with systolic (r=−0.349) and diastolic BP (r=−0.441), waist circumference (r=−0.345), total cholesterol (r=−0.348), high-density lipoprotein (HDL) (r=0.362), UAE (r=−0.486), homeostasis model assessment (HOMA-IR) (r=−0.467), uric acid (r=−0.316), and hsCRP (r=−0.217, only in women subgroup) (P<.05). With the exception of the latter three variables, the above associations remained significant after controlling for age and sex in multiple regression analysis (P<.05). Compared to LF group, patients in MF group showed significantly higher levels of HDL and lower levels of BP, waist circumference, hsCRP, and HOMA-IR (P<.05). In addition to this, UAE tended to be lower in fit patients (P=.054). Conclusions: Low cardiorespiratory fitness seems to be independently associated with most traditional and emerging cardiovascular risk factors in patients with T2DM. Even a moderate increase of cardiorespiratory fitness exerts beneficial effects on cardiovascular risk profile. [Copyright &y& Elsevier]