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A High-Throughput Multiplexed Screening for Type 1 Diabetes, Celiac Diseases, and COVID-19
Published on: July 5, 2022
Should we screen for occult coronary artery disease among asymptomatic patients with diabetes?
Marcelo F Di Carli1, Rory Hachamovitch
1Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. mdicarli@partners.org
Insights
Diabetes mellitus significantly increases the risk of coronary artery disease (CAD), even in asymptomatic individuals. Myocardial perfusion SPECT effectively diagnoses CAD in diabetics, but screening asymptomatic patients remains challenging.
Area of Science:
- Cardiology
- Diabetology
- Nuclear Medicine
Background:
- Diabetes mellitus is a major risk factor for premature atherosclerotic coronary artery disease (CAD).
- Diabetics without diagnosed CAD face myocardial infarction risks comparable to non-diabetics with prior heart attacks.
- Occult CAD is prevalent in asymptomatic diabetics, affecting 20% to over 50%.
Purpose of the Study:
- To evaluate the diagnostic accuracy and prognostic value of myocardial perfusion single-photon emission computed tomography (SPECT) in diabetic patients.
- To assess the challenges in screening asymptomatic diabetics for CAD.
- To explore efficient screening strategies for asymptomatic diabetic individuals.
Main Methods:
- Analysis of diagnostic accuracy of myocardial perfusion SPECT in diabetics compared to non-diabetics.
- Correlation of ischemic burden assessed by stress SPECT with cardiovascular event risk in diabetic subjects.
- Evaluation of SPECT yield in diabetic patients with specific clinical indicators (abnormal ECG, peripheral/carotid disease, dyspnea).
Main Results:
- Myocardial perfusion SPECT demonstrates comparable diagnostic accuracy in diabetics and non-diabetics.
- Increased ischemic burden on stress SPECT correlates with higher adverse cardiovascular event risk in diabetics.
- Diabetics with normal stress SPECT still exhibit a significantly higher risk than non-diabetics.
- Testing symptomatic diabetics or those with specific comorbidities yields a high rate of abnormal SPECT findings.
- Screening asymptomatic diabetics without overt CAD presents a significant challenge for achieving adequate diagnostic yield.
Conclusions:
- Myocardial perfusion SPECT is a valuable tool for diagnosing and assessing risk in diabetic patients with suspected CAD.
- Even with normal SPECT results, diabetic patients face elevated cardiovascular risk.
- Further research into sequential testing strategies is crucial for effective screening of asymptomatic diabetics.
Abstract:
Diabetes mellitus predisposes people to premature atherosclerotic coronary artery disease (CAD). The risk of a myocardial infarction in diabetics without overt evidence of obstructive CAD matches that of patients without diabetes who have had a previous myocardial infarction. The available data suggest that occult CAD is a common finding among asymptomatic diabetics, ranging from 20% to >50%. The diagnostic accuracy of myocardial perfusion single-photon emission computed tomography (SPECT) in diabetics appears to be comparable to that observed in nondiabetic individuals. As shown in other patient groups, the ischemic burden assessed by stress SPECT in subjects with diabetes is also linked to their increased risk of adverse cardiovascular events. Among patients with normal stress SPECT, however, those with diabetes are at significantly greater risk than non-diabetics. Testing diabetics with an abnormal resting electrocardiogram or with evidence of peripheral or carotid occlusive arterial disease appears to result in an excellent yield of abnormal SPECT findings, as does testing in the setting of dyspnea. However, recent evidence suggests that achieving an adequate yield in asymptomatic diabetics without overt evidence of CAD is a greater challenge. Further investigation of sequential testing strategies is needed in order to identify an efficient means for screening asymptomatic patients with diabetes.
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