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Clinical value and severity of myocardial perfusion defects in asymptomatic diabetic patients with negative or weakly
Seyed Rasoul Zakavi1, Mehdi Taherpour2, Zohreh Moossavi3
1Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Asymptomatic type 2 diabetes patients often have mild myocardial perfusion defects, detectable by exercise treadmill testing and myocardial perfusion imaging. These findings, while common, do not predict adverse cardiac events in the short term.
Area of Science:
- Cardiology
- Diabetology
- Nuclear Medicine
Background:
- Coronary artery disease (CAD) is a major cause of mortality in type 2 diabetes mellitus (T2DM).
- Diabetic patients with CAD often remain asymptomatic.
- Myocardial perfusion imaging (MPI) can detect ischemia in asymptomatic individuals.
Purpose of the Study:
- To investigate the prevalence and severity of myocardial perfusion defects in asymptomatic T2DM patients.
- To assess the clinical impact of these defects on cardiac events.
Main Methods:
- 130 asymptomatic T2DM patients (age 35-65) without prior CAD underwent echocardiography, ECG, lab tests, and exercise treadmill test (ETT).
- Patients with non-negative ETT results had Dipyridamole MPI; positive ETT led to coronary angiography.
- Follow-up for cardiac events was conducted for at least 17 months.
Main Results:
- 74.3% had negative ETT, 15% weakly positive, 10.7% positive. Angiography confirmed CAD in 75% of positive ETT patients.
- MPI revealed reversible defects in 26.9% of patients, with a mean summed stress score of 3.3±1.8.
- Higher blood glucose, HbA1c, TG/HDL ratio, and end-diastolic volume were associated with ischemia.
Conclusions:
- Reversible myocardial perfusion defects are common in asymptomatic T2DM patients but are typically mild.
- These defects did not correlate with adverse cardiac events during the follow-up period.
- Standard CAD detection using ETT followed by MPI is appropriate for asymptomatic T2DM patients.
Objective:
Although coronary artery disease (CAD) is the leading cause of death in type 2 diabetic patients, it is frequently asymptomatic. Myocardial perfusion imaging (MPI) is reported to show ischemia in a significant number of asymptomatic diabetic patients. We studied the prevalence and severity of myocardial perfusion defects in asymptomatic diabetic patients and its clinical impact.
Methods And Patients:
One hundred thirty consecutive asymptomatic patients, aged 35-65 years with type 2 diabetes mellitus and with no history of CAD and no cardiac symptoms were recruited in the study. Echocardiography, electrocardiography (ECG), routine laboratory tests and exercise treadmill test (ETT) were performed and patients with weakly positive or negative ETT underwent Dipyridamole MPI. Patients with positive ETT were referred to coronary angiography. Patients were followed for at least 17 months (mean 21.7 months) and any cardiac event was recorded.
Results:
We studied 81 female and 49 male patients with mean age of 51.8 years. Negative, weakly positive and positive ETT result was noted in 74.3%, 15% and 10.7% respectively. 75% of patients with positive ETT had coronary artery disease in angiography. Gated myocardial perfusion SPECT was done in 106 patients. MPI showed reversible defect in 26.9% of the patients with a mean summed stress score of 3.3±1.8. Follow up completed in 112 patients and only one patient with abnormal MPI underwent coronary angiography followed by PTCA. No cardiac death, MI, UA or hospital admission occurred among our patients during follow up (17-26 months). Mean stress end diastolic volume (EDV) was significantly higher in patients with reversible defect compared to patients without reversible defect based on MPI findings (62.0±31.6 Vs 48.5±18.4 ml, P=0.04). Blood glucose and HbA1c were significantly higher in patients with ischemia compared to patients without ischemia (P<0.05). Meanwhile the ratio of TG to HDL was 6.06±3.2 in ischemic patients compared to 4.8±2.3 in normal subjects (P=0.03).
Conclusion:
Reversible defects are commonly seen in myocardial perfusion SPECT in asymptomatic diabetic patients and are mild in severity and not associated with adverse cardiac events. Routine approach for detection of CAD beginning with ETT seems to be appropriate in these patients.
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