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Diabetic cardiomyopathy: the relationship between 201-thallium myocardial scintigraphic perfusion defect and left
1Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Insights
Myocardial perfusion defects are common in asymptomatic diabetics and may indicate early cardiac dysfunction. These abnormalities, detected via scintigraphy, suggest underlying metabolic issues impacting heart health.
Area of Science:
- Cardiology
- Diabetology
- Nuclear Medicine
Background:
- Diabetes mellitus is associated with an increased risk of cardiovascular disease.
- Asymptomatic individuals with diabetes may have subclinical cardiac abnormalities.
- Myocardial perfusion imaging can detect early signs of cardiac dysfunction.
Purpose of the Study:
- To investigate the prevalence and significance of myocardial perfusion defects in asymptomatic diabetic men.
- To correlate perfusion abnormalities with cardiac function parameters in this population.
Main Methods:
- 40 mildly diabetic men without known ischemic heart disease underwent myocardial scintigraphy.
- Evaluations included radionuclide ventriculography, echocardiography, and assessment of cardiac output.
- Patients were categorized based on the severity of perfusion defects (G1: none, G2: mild, G3: moderate).
Main Results:
- 40% of participants showed no perfusion defects; mild to moderate defects were observed in the remainder.
- Obesity index was significantly higher in the moderate defect group (G3).
- Echocardiography revealed decreased fractional shortening in G2 and G3 groups.
- Radionuclide ventriculography showed reduced peak filling rate and cardiac output increase in G3.
Conclusions:
- Myocardial scintigraphic perfusion abnormalities are detectable in asymptomatic diabetics.
- These perfusion defects may represent early metabolic derangements contributing to myocardial dysfunction.
- Perfusion imaging can identify diabetic patients at risk for cardiac complications.
Abstract:
To investigate the significance of perfusion defects in asymptomatic diabetics, 40 mildly diabetic men, mean age 49 +/- 9.7 years, without clinical or exercise electrocardiographic evidence of ischemic cardiac disease, were evaluated: 1) sixteen (40%) showed no filling defect (G1). Mild defects (G2) and moderate defects (G3) were observed in 12 and 12, respectively; 2) the percent washout ratio was diminished in none of G1, in 3 of G2 and in 11 of G3; 3) there were no differences in age, duration of diabetes, FBS, HbA1c, serum cholesterol, smoking or BP. Obesity index was greater in G3 (121 +/- 15%, p less than 0.01) compared to G1 and 2 (103 +/- 9%, 108 +/- 9%); 4) the percent fractional shortening by echo was decreased in G2 and G3 (35 +/- 6%, 33 +/- 8%, p less than 0.01) compared to G1 (42 +/- 5%). The systolic time interval was higher in G3 (0.42 +/- 0.09, p less than 0.05) compared to G1 and G2 (0.35 +/- 0.05, 0.36 +/- 0.06); 5) radionuclide ventriculographic studies showed a lower peak filling rate at rest in G2 (2.4 +/- 0.5 EDV/sec, p less than 0.025) compared to G3 and G1 (2.9 +/- 0.6 EDV/sec, 3.2 +/- 0.7 EDV/sec). The rate of increase in cardiac output was significantly lower in G3 compared to G1 and G2 (59 +/- 28%, 96 +/- 49%, 97 +/- 31%, p less than 0.05). These results suggest the possibility of detecting metabolic derangements was myocardial scintigraphic perfusion abnormalities which might be a causal factor of myocardial dysfunction in diabetics.