Interrelationship between myocardial perfusion imaging, coronary calcium score, and endothelial function in asymptomatic diabetics and controls

Peix, Amalia; Cabrera, Lázaro O.; Heres, Flor; Rodríguez, Lydia; Valdés, Alexander; Valiente, Juan; García, Raymid; Licea, Manuel; Mendoza, Valeria Yalharahi Naif; Gárciga, Francisco Felipe Hernández; Rodríguez, Yaquelin; Carrillo, Regla; Mena, Erick; Fernández, Yoel; Montero, Minerva; Dondi, Maurizio

doi:10.1007/s12350-011-9355-2

Cited by 16 publications

(16 citation statements)

References 42 publications

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“…Endothelial dysfunction may be considered as a cardiovascular risk factor or at least as a cardiovascular risk marker [12,25], but impairment of vascular smooth muscle cell function has been also reported in diabetic patients [9] and may be involved in altered FMD. The mechanism of impaired FMD cannot be explained in our results since we did not test specifically vascular smooth muscle cell function, like Peix et al [14]. The absence of significant difference between patients who constricted their brachial artery and those who did not for VCAM and albuminuria, which are usually considered as endothelium markers [26], might be consistent with the role of impaired smooth muscle cell function in our population.…”

Section: Discussionsupporting

confidence: 80%

“…When the cardiovascular risk profile of the patients was intermediate as in Peix et al . study (diabetes duration 11 years, age 58 years, hypertension, dyslipidemia and smoking habits in 77%, 73% and 32% of the patients, respectively), there was a higher prevalence of abnormal FMD in those with SMI as compared with those without, whereas no difference was found for the mean values of FMD [14]. As reported by Naka et al , duration of diabetes appears to be an important factor for developing impaired FMD [33].…”

Section: Discussionmentioning

confidence: 94%

“…The association between endothelial and smooth muscle dysfunction evaluated by flow-mediated dilation (FMD) and SMI in patients with type 2 diabetes has been previously studied. Some authors did not find any association but reported a high negative predictive value for SMI when the endothelial function was normal [13], whereas others reported a higher prevalence of SMI in the patients with abnormal FMD [14]. However, these series included a limited number of subjects, whose a priori cardiovascular risk was lower than what has been recommended for SMI screening [2,15].…”

Section: Introductionmentioning

confidence: 99%

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Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients

Nguyen

Pham

Valensi

et al. 2014

Cardiovasc Diabetol

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BackgroundTo investigate whether flow-mediated dilation (FMD) impairment, which precedes overt atherosclerosis, is associated with silent myocardial ischemia (SMI) and asymptomatic coronary artery disease (CAD) in type 2 diabetes.MethodsForearm FMD was measured by ultrasonography in 25 healthy control, 30 non-diabetic overweight or obese patients and 118 asymptomatic type 2 diabetic patients with a high cardiovascular risk profile. SMI (abnormal stress myocardial scintiscan and/or stress dobutamine echocardiogram) and CAD (coronary angiography in the patients with SMI) were assessed in the diabetic cohort.ResultsFMD was lower in diabetic patients (median 0.61% (upper limits of first and third quartiles -1.22;3.2)) than in healthy controls (3.95% (1.43;5.25), p < 0.01) and overweight/obese patients (4.25% (1.74;5.56), p < 0.01). SMI was present in 60 diabetic patients, including 21 subjects with CAD. FMD was lower in patients with SMI than in those without (0.12% (-2.3;1.58) vs 1.64% (0;3.69), p < 0.01), with a higher prevalence of paradoxical vasoconstriction (50.0% vs 29.3%, p < 0.05). FMD was also lower in patients with than without CAD (-1.22% (-2.5;1) vs 1.13% (-0.4;3.28), p < 0.01; paradoxical vasoconstriction 61.9% vs 34.4%, p < 0.05). Logistic regression analyses considering the parameters predicting SMI or CAD in univariate analyses with a p value <0.10 showed that paradoxical vasoconstriction (odds ratio 2.7 [95% confidence interval 1.2-5.9], p < 0.05) and nephropathy (OR 2.6 [1.2-5.7], p < 0.05) were independently associated with SMI; and only paradoxical vasoconstriction (OR 3.1 [1.2-8.2], p < 0.05) with CAD. The negative predictive value of paradoxical vasoconstriction to detect CAD was 88.7%.ConclusionsIn diabetic patients, FMD was independently associated with SMI and asymptomatic CAD.Trial registrationTrial registration number NCT00685984.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients

Nguyen

Pham

Valensi

et al. 2014

Cardiovasc Diabetol

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“…Our small study sample may have obscured any such possible association, nevertheless it should be kept in mind that diabetic complications do not have to follow a particular sequence. Our findings seem to be in line with those of Peix et al, (21) who showed that the presence of DM was the only predictor of abnormal myocardial perfusion and that total cholesterol/HDL ratio greater than 4 was correlated with perfusion abnormalities. In the DIAD study, where 522 diabetic patients were evaluated with adenosine MPI, an abnormal stress test result was not significantly associated with demographic characteristics, traditional cardiac risk factors, or laboratory variables (4).…”

Section: Discussionsupporting

confidence: 93%

Evaluation of Silent Myocardial Ischemia with Single-Photon Emission Computed Tomography/Computed Tomography in Asymptomatic Subjects with Diabetes and Pre-Diabetes

Özdemir¹,

Polat²,

Yıldırım³

et al. 2016

Mirt

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Objective:The aim of this study was to disclose the prevalence of myocardial ischemia, as detected by adenosine stress myocardial perfusion imaging (MPI) with hybrid single-photon emission computed tomography/computed tomography (SPECT/CT), in asymptomatic diabetic and pre-diabetic patients and to find out whether ischemia predicted the occurrence of adverse cardiac/cerebrovascular events (ACCE) at follow-up.Methods:Forty-three diabetic and thirty-five pre-diabetic asymptomatic patients without any history of coronary artery disease, underwent MPI and were followed-up for a 12.8±2.2 (8-19) months for the occurrence of ACCE. Baseline variables that would predict the presence of ischemia and the value of ischemia on MPI for predicting the occurrence of ACCE at follow-up were evaluated by logistic regression analysis.Results:Ischemia was detected in ten (23.3%) of the diabetic and in four (11.4%) of the pre-diabetic patients. The presence of diabetes was the only independent predictor of myocardial ischemia [odds ratio (OR): 12.31, 95% confidence interval (CI): 1.83-82.66; p<0.01]. During 12.8±2.2 (8-19) months of follow-up, ACCE was observed in five out of 78 (6.4%) patients. Patients with ischemia were significantly more likely to have ACCE during follow-up as compared to those with normal MPI scans (event rates: 21.4% vs. 3.1%, OR: 8.455 95% CI: 1.264-56.562, p=0.038).Conclusion:Myocardial ischemia as detected by adenosine stress SPECT/CT in a population of asymptomatic patients with diabetes mellitus or pre-diabetes appeared to predict the occurrence of ACCE at follow-up.

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“…Several studies have used different algorithms to identify diabetic patients who should or should not be referred for MPS. These algorithms have been based on numbers of traditional or emerging cardiovascular risk factors, the presence or absence of endothelium-dependent vasodilatation, the results of exercise ECG, or CAC score measurements [30,[85][86][87][88][89]. In particular, the presence of CAC is associated with a subsequent risk of cardiac events, with 1-99 Agatston units indicating low risk; 100-400 moderate risk; and [400 high risk [90].…”

Section: Which Diabetic Patients Should Be Referred For Mps?mentioning

confidence: 99%

Cardiovascular risk stratification in diabetic patients

Cuocolo

Concilio²,

Acampa

et al. 2013

Clin Transl Imaging

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Several studies, reporting that diabetes is associated with a marked increase in the risk of coronary artery disease (CAD), introduced the concept that diabetes is CAD equivalent, and thereby provided a rationale for treating cardiovascular risk factors in diabetic patients as aggressively as in non-diabetic subjects with prior myocardial infarction. However, the concept of CAD risk equivalence in diabetes has been challenged by other studies. The classification of individuals with diabetes as having a risk level equivalent to that of individuals without diabetes who survived a cardiovascular event is an approach that fails to account for the fact that cardiovascular risk is not uniformly distributed, but follows a gradient from the lowest to the highest risk. Prediction models, based on numbers of risk factors, have been proposed for patients with diabetes. Most cardiovascular prediction models have been developed in general populations, including diabetes as a predictor, while a smaller number of studies have endeavored to construct CAD risk scores primarily in diabetic patients. The detection of occult CAD is the objective of non-invasive of testing diabetic patients for risk stratification purposes. Among the non-invasive imaging modalities, stress myocardial perfusion singlephoton emission computed tomography has been widely used in diabetic patients. This review discusses the importance of using clinical prediction models in the diabetic population and the different challenges of non-invasive imaging for risk stratification, considering that the questions of when, how, and which diabetic patients should be studied are still open ones.

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Interrelationship between myocardial perfusion imaging, coronary calcium score, and endothelial function in asymptomatic diabetics and controls

Abstract: Reversible perfusion defects and coronary calcium are more frequent in diabetics. CCS, abnormal endothelium-dependent vasodilation, and cholesterol/HDL ratio higher than 4, showed an association with perfusion abnormalities in asymptomatic diabetics.

Cited by 16 publications

References 42 publications

Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients

Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients

Evaluation of Silent Myocardial Ischemia with Single-Photon Emission Computed Tomography/Computed Tomography in Asymptomatic Subjects with Diabetes and Pre-Diabetes

Cardiovascular risk stratification in diabetic patients

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