SPECT myocardial perfusion imaging

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

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