Myocardial Perfusion SPECT Utility in Predicting Cardiovascular Events Among Indonesian Diabetic Patients

Abstract

Background: Indonesia has the fourth largest number of diabetes patients after India, China and the USA. Coronary artery disease (CAD) is the most common cause of death in diabetic patients. Early detection and risk stratification is important for optimal management. Abnormal myocardial perfusion imaging (MPI) is an early manifestation in the ischemic cascade. Previous studies have demonstrated the use of MPI to accurately diagnose obstructive CAD and predict adverse cardiac events. This study evaluated whether MPI predicts adverse cardiac event in an Indonesian diabetic population.Method: The study was undertaken in a consecutive cohort of patients with suspected or known CAD fulfilling entry criteria. All had adenosine stress MPI. The end point was a major adverse cardiac event (MACE) defined as cardiac death or nonfatal myocardial infarction (MI).Results: Inclusion and exclusion criteria were satisfied by 300 patients with a mean follow-up of 26.7 ± 8.8 months. The incidence of MACEs was 18.3% among diabetic patients, versus 9% in the non-diabetic population (p < 0.001). A multivariable Cox proportional hazard model demonstratedin dependent predictors for a MACE as abnormal MPI [HR: 9.30 (3.01 – 28.72), p < 0.001], post stress left ventricular ejection fraction (LVEF) ≤30% [HR:2.72 (1.21 – 6.15), p = 0.016] and the patients diabetic status [HR:2.28 (1.04 – 5.01), p = 0.04]. The Kaplan Meier event free survival curve constructed for the different subgroups based on the patients’ diabetic status and MPI findings demonstrated that diabetic patients with an abnormal MPI had the worst event free survival (log rank p value < 0.001).Conclusions: In an Indonesian population with suspected or known CAD abnormal adenosine stress MPI is an independent and potent predictor for adverse cardiovascular events and provides incremental prognostic value in cardiovascular risk stratification of patients with diabetes.

Seguimiento a Cinco Años en Pacientes Diabéticos Sin Síntomas Cardíacos Estudiados Con Perfusión Miocárdica

“…La perfusión anormal en estrés fue un predictor independiente y potente para los eventos mayores con valor pronóstico incremental en la estratificación de riesgo cardiovascular de DM. 15 Por otra parte, el resultado del SPECT en 1.427 DM asintomáticos estratificados de acuerdo al resultado del SPECT en bajo, mediano y alto riesgo, mostró diferencias significativas en la tasa de mortalidad anual entre los grupos. 16 Otro trabajo prospectivo reciente presenta 575 pacientes consecutivos con DM con riesgo intermedio de EC, 40.3% de ellos con EC conocida y 29% asintomáticos.…”

Association Between Type 2 Diabetes Mellitus and the Presence of Myocardial Ischemia among Filipino Patients with Stress Myocardial Perfusion Scintigraphy

“…Diabetes mellitus (DM) is a significant health problem with great importance [1]. It has an estimated worldwide prevalence of 200 million as of 2007 and projected to balloon to 300 million in 2025 [2].…”

“…Coronary artery disease (CAD) is the leading cause of death among type 2 DM patients [1], [4]- [7]. Myocardial ischemia in these patients are usually silent and in advanced stage once they clinically manifest [4]- [5], [8]- [9].…”

“…The role of single-photon emission computed tomography (SPECT) in evaluation for myocardial ischemia has been extensively studied [1], [4], [6]- [7]. In general, the sensitivity and specificity of SPECT for CAD detection are 86% and 74%, respectively [6,11].…”

“…Current opinion regarding evaluation of CAD in type 2 DM patients is to recommend stress myocardial perfusion scintigraphy (MPS) [7]. The usefulness of this approach is still under study, however there were promising results [1], [4]- [5], [7], [11]. In the Philippines, there are no current available data regarding this matter.…”