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The prognostic efficacy of myocardial perfusion imaging in optimally treated diabetic patients with no manifestations of coronary artery disease
- Source :
- Nuclear medicine communications. 34(9)
- Publication Year :
- 2013
-
Abstract
- 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.
- Subjects :
- Male
medicine.medical_specialty
Adenosine
medicine.medical_treatment
Type 2 diabetes
Coronary Artery Disease
Revascularization
Coronary artery disease
Diabetes Complications
Myocardial perfusion imaging
Stress, Physiological
Internal medicine
Diabetes mellitus
medicine
Diabetes Mellitus
Humans
Radiology, Nuclear Medicine and imaging
Myocardial infarction
Retrospective Studies
medicine.diagnostic_test
business.industry
Hazard ratio
Myocardial Perfusion Imaging
General Medicine
Middle Aged
medicine.disease
Prognosis
Survival Analysis
Heart failure
Cardiology
Female
business
Subjects
Details
- ISSN :
- 14735628
- Volume :
- 34
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- Nuclear medicine communications
- Accession number :
- edsair.doi.dedup.....5777381a44ea49534cb5d8d755d89347