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Nuklearmedizin 2006; 45(02): 74-81
DOI: 10.1055/s-0038-1623937
Original Article
Schattauer GmbH

SPECT myocardial perfusion imaging

Long-term prognostic value in diabetic patients with and without coronary artery diseaseMyokardperfusion-SPECTStellenwert in der Langzeit- Prognose diabetischer Patienten mit und ohne koronarer Herzkrankheit
M. Koehli
1   Department of Endocrinology, Diabetology and Metabolism, University Hospital Lausanne, Switzerland
2   Department of Nuclear Medicine, University Hospital Lausanne, Switzerland
,
D. Monbaron
1   Department of Endocrinology, Diabetology and Metabolism, University Hospital Lausanne, Switzerland
,
J. O. Prior
2   Department of Nuclear Medicine, University Hospital Lausanne, Switzerland
,
M. L. Calcagni
2   Department of Nuclear Medicine, University Hospital Lausanne, Switzerland
3   Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Roma, Italy
,
M. Fivaz-Arbane
4   Department of Cardiology, University Hospital Lausanne, Switzerland
,
J. C. Stauffer
4   Department of Cardiology, University Hospital Lausanne, Switzerland
,
R. C. Gaillard
1   Department of Endocrinology, Diabetology and Metabolism, University Hospital Lausanne, Switzerland
,
A. Bischof Delaloye
2   Department of Nuclear Medicine, University Hospital Lausanne, Switzerland
,
J. Ruiz
1   Department of Endocrinology, Diabetology and Metabolism, University Hospital Lausanne, Switzerland
› Author Affiliations
Further Information

Publication History

Received: 06 December 2004

04 August 2005

Publication Date:
11 January 2018 (online)

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Summary

Aim: To determine the long-term prognostic value of SPECT myocardial perfusion imaging (MPI) for the occurrence of cardiovascular events in diabetic patients. Patients, methods: SPECT MPI of 210 consecutive Caucasian diabetic patients were analysed using Kaplan-Meier event-free survival curves and independent predictors were determined by Cox multivariate analyses. Results: Follow-up was complete in 200 (95%) patients with a median period of 3.0 years (0.8-5.0). The population was composed of 114 (57%) men, age 65 ±10 years, 181 (90.5%) type 2 diabetes mellitus, 50 (25%) with a history of coronary artery disease (CAD) and 98 (49%) presenting chest pain prior to MPI. The prevalence of abnormal MPI was 58%. Patients with a normal MPI had neither cardiac death, nor myocardial infarction, independently of a history of coronary artery disease or chest pain. Among the independent predictors of cardiac death and myocardial infarction, the strongest was abnormal MPI (p <0.0001), followed by history of CAD (Hazard Ratio (HR)=15.9; p=0.0001), diabetic retinopathy (HR=10.0; p=0.001) and inability to exercise (HR=7.7; p=0.02). Patients with normal MPI had a low revascularisation rate of 2.4% during the followup period. Compared to normal MPI, cardiovascular events increased 5.2 fold for reversible defects, 8.5 fold for fixed defects and 20.1 fold for the association of both defects. Conclusion: Diabetic patients with normal MPI had an excellent prognosis independently of history of CAD. On the opposite, an abnormal MPI led to a >5-fold increase in cardiovascular events. This emphasizes the value of SPECT MPI in predicting and risk-stratifying cardiovascular events in diabetic patients.

Zusammenfassung

Ziel: Erfassung des prognostischen Stellenwertes der Myokardperfusion- SPECT (MPS) im Hinblick auf kardiovaskuläre Ereignisse bei Patienten mit Diabetes mellitus. Patienten, Methoden: 210 konsekutive diabetische Patienten wurden untersucht. Die ereignisfreie Überlebenszeit wurde nach der Kaplan-Meier-Methode berechnet, unabhängige prognostische Parameter mit Hilfe der multivariaten Cox- Analyse bestimmt. Ergebnisse: Vollständige Verlaufskontrollen wurden bei 200 Patienten (95%) durchgeführt, bei einer medianen Beobachtungszeit von 3.0 (0.8-5.0) Jahren. 114 Patienten (57%) waren Männer, das Lebensalter war 65 ± 10 Jahre, 181 (90,5%) hatten einen Typ-2-Diabetes, 50 (25%) eine bekannte koronare Herzkrankheit (KHK) und 98 (49%) anginöse Beschwerden vor der MPS. Die Prävalenz einer abnormalen MPS war 58%. Bei Patienten mit normaler MPS wurde, unabhängig von vorbestehender KHK oder anginösen Beschwerden, kein Fall von Herztod noch Myokardinfarkt beobachtet. Abnormale MPS (p <0,0001), KHK-Anamnese (hazard ratio, HR = 15,9; p = 0,0001), diabetische Retinopathie (HR = 10,0; p = 0,001) und ergometrische Belastungsunfähigkeit (HR = 7,7; p = 0,02) waren die stärksten Prädiktoren kardiovaskulärer Ereignisse. Die Revaskularisationsrate während der Verlaufsbeobachtung war bei Patienten mit normaler MPS gering (2,4%). Im Vergleich zu Patienten mit normaler MPS vervielfachten sich die kardiovaskulären Ereignisse um den Faktor 5,2 bei Patienten mit reversiblen, 8,5 bei solchen mit fixen und 20,1 bei solchen mit gemischten Defekten. Schlussfolgerung: Diabetische Patienten mit normaler MPS haben eine ausgezeichnete Prognose, die unabhängig von der KHK-Anamnese ist. Dagegen war eine abnormale MPS mit einer mehr als fünffachen Erhöhung kardiovaskulärer Ereignisse verbunden. Diese Ergebnisse unterstreichen den Wert der MPS für Prognose und Risikostratifizierung von Patienten mit Diabetes mellitus.

Keywords

Diabetes mellitus - coronary artery disease - myocardial ischemia - prognostic value - single-photon emission computed tomography myocardial perfusion imaging

Schlüsselwörter

Diabetes mellitus - koronare Herzkrankheit - Myokardischämie - Prognose; Myokardperfusion - SPECT
 

  • References

  • 1 Airaksinen KE. Silent coronary artery disease in diabetes--a feature of autonomic neuropathy or accelerated atherosclerosis?. Diabetologia 2001; 44: 259-66.
    CrossrefPubMedGoogle Scholar
  • 2 Berman DS, Kiat H, Friedman JD. et al. Separate acquisition rest thallium-201/stress technetium- 99m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: a clinical validation study. J Am Coll Cardiol 1993; 22: 1455-64.
    CrossrefPubMedGoogle Scholar
  • 3 Consensus development conference on the diagnosis of coronary heart disease in people with diabetes: 10–11 February 1998, Miami, Florida.. American Diabetes Association. Diabetes Care 1998; 21: 1551-9.
    CrossrefPubMedGoogle Scholar
  • 4 De Lorenzo A, Lima RS, Siqueira-Filho AG. et al. Prevalence and prognostic value of perfusion defects detected by stress technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography in asymptomatic patients with diabetes mellitus and no known coronary artery disease. Am J Cardiol 2002; 90: 827-32.
    CrossrefPubMedGoogle Scholar
  • 5 Definition, diagnosis and classification of diabetes mellitus and its complications.. Part 1: diagnosis and classification of diabetes mellitus. World Health Organization 1999
    PubMedGoogle Scholar
  • 6 Fagan TJ. Nomogram for Bayes theorem. N Engl J Med 1975; 293: 257.
    PubMedGoogle Scholar
  • 7 Felsher J, Meissner MD, Hakki AH. et al. Exercise thallium imaging in patients with diabetes mellitus. Prognostic implications. Arch Intern Med 1987; 147: 313-7.
    CrossrefPubMedGoogle Scholar
  • 8 Garber AM, Solomon NA. Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease. Ann Intern Med 1999; 130: 719-28.
    CrossrefPubMedGoogle Scholar
  • 9 Giri S, Shaw LJ, Murthy DR. et al. Impact of diabetes on the risk stratification using stress singlephoton emission computed tomography myocardial perfusion imaging in patients with symptoms suggestive of coronary artery disease. Circulation 2002; 105: 32-40.
    CrossrefPubMedGoogle Scholar
  • 10 Guidelines for cardiac exercise testing.. ESC Working Group on Exercise Physiology, Physiopathology and Electrocardiography. Eur Heart J 1993; 14: 969-88.
    CrossrefPubMedGoogle Scholar
  • 11 Hachamovitch R, Berman DS, Shaw LJ. et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998; 97: 535-43.
    CrossrefPubMedGoogle Scholar
  • 12 Hachamovitch R, Hayes SW, Friedman JD. et al. Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD. J Am Coll Cardiol 2004; 43: 200-8.
    CrossrefPubMedGoogle Scholar
  • 13 Howard BV, Rodriguez BL, Bennett PH. et al. Prevention Conference VI: Diabetes and Cardiovascular disease: Writing Group I: epidemiology. Circulation 2002; 105: e132-7.
    CrossrefPubMedGoogle Scholar
  • 14 Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).. UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352 9131 837-53.
    CrossrefPubMedGoogle Scholar
  • 15 Janand-Delenne B, Savin B, Habib G. et al. Silent myocardial ischemia in patients with diabetes: who to screen. Diabetes Care 1999; 22: 1396-400.
    CrossrefPubMedGoogle Scholar
  • 16 Kang X, Berman DS, Lewin HC. et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography in patients with diabetes mellitus. Am Heart J 1999; 138: 1025-32.
    CrossrefPubMedGoogle Scholar
  • 17 Papaioannou GI, Heller GV. Risk assessment by myocardial perfusion imaging for coronary revascularization, medical therapy, and noncardiac surgery. Cardiol Rev 2003; 11: 60-72.
    CrossrefPubMedGoogle Scholar
  • 18 Passa P, Drouin P, Issa-Sayegh M. et al. Coronary disease and diabetes. Diabete Metab 1995; 21: 446-51.
    PubMedGoogle Scholar
  • 19 Patterson RE, Eng C, Horowitz SF. Practical diagnosis of coronary artery disease: a Bayes’ theorem nomogram to correlate clinical data with noninvasive exercise tests. Am J Cardiol 1984; 53: 252-6.
    CrossrefPubMedGoogle Scholar
  • 20 Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 2001; 103: 1813-8.
    CrossrefPubMedGoogle Scholar
  • 21 Rose GBH, Gillum RF, Prineas RJ. Cardiovascular Survey Methods. Geneva: 1982
    PubMedGoogle Scholar
  • 22 Ruiz J, Keller U, Bulliard C. Prevention and screening of coronary artery disease in the diabetic patient. Bull Med Suisse 2000; 81: 2596-600.
    Google Scholar
  • 23 Schinkel AF, Elhendy A, van Domburg RT. et al. Prognostic value of dobutamine-atropine stress myocardial perfusion imaging in patients with diabetes. Diabetes Care 2002; 25: 1637-43.
    CrossrefPubMedGoogle Scholar
  • 24 Stamler J, Vaccaro O, Neaton JD. et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993; 16: 434-44.
    CrossrefPubMedGoogle Scholar
  • 25 Torremocha F, Hadjadj S, Carrie F. et al. Prediction of major coronary events by coronary risk profile and silent myocardial ischaemia: prospective follow-up study of primary prevention in 72 diabetic patients. Diabetes Metab 2001; 27: 49-57.
    PubMedGoogle Scholar
  • 26 Vanzetto G, Halimi S, Hammoud T. et al. Prediction of cardiovascular events in clinically selected high-risk NIDDM patients. Prognostic value of exercise stress test and thallium-201 singlephoton emission computed tomography. Diabetes Care 1999; 22: 19-26.
    CrossrefPubMedGoogle Scholar
  • 27 Vitola JV, Brambatti JC, Caligaris F. et al. Exercise supplementation to dipyridamole prevents hypotension, improves electrocardiogram sensitivity, and increases heart-to-liver activity ratio on 99mTc sestamibi imaging. J Nucl Cardiol 2001; 8: 652-9.
    CrossrefPubMedGoogle Scholar
  • 28 Wackers FJ, Young LH, Inzucchi SE. et al. Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects: The DIAD study. Diabetes Care 2004; 27: 1954-61.
    CrossrefPubMedGoogle Scholar
  • 29 Zellweger MJ, Hachamovitch R, Kang X. et al. Prognostic relevance of symptoms versus objective evidence of coronary artery disease in diabetic patients. Eur Heart J 2004; 25: 543-50.
    CrossrefPubMedGoogle Scholar