Prediction of cardiovascular events in clinically selected high-risk NIDDM patients. Prognostic value of exercise stress test and thallium-201 single-photon emission computed tomography.

Vanzetto, Gérald; Halimi, Serge; Hammoud, Talal; Fagret, Daniel; Py, Benhamou; Cordonnier, D; Denis, B; Machecourt, J

doi:10.2337/diacare.22.1.19

Cited by 111 publications

(64 citation statements)

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“…However, it is important to recognize that, irrespective of cause, patients who are unable to exercise are at increased cardiac risk. The incidence of inducible ischemia is increased in these patients and when present portends a very poor prognosis (42). Multiple cardiac risk factors.…”

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confidence: 99%

Screening for Coronary Artery Disease in Patients With Diabetes

et al. 2007

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Coronary artery disease (CAD) accounts for a large fraction of the morbidity, mortality, and cost of diabetes. Recognizing this, nearly 10 years ago the American Diabetes Association published a consensus recommendation that clinicians consider a risk factor–guided screening approach to early diagnosis of CAD in both symptomatic and asymptomatic patients. Subsequent clinical trial results have not supported those recommendations. Since the prior consensus statement, newer imaging methods, such as coronary artery calcium scoring and noninvasive angiography with computed tomography (CT) techniques, have come into use. These technologies, which allow quantitation of atherosclerotic burden and can predict risk of cardiac events, might provide an approach to more widespread coronary atherosclerosis screening. However, over this same time interval, there has been recognition of diabetes as a cardiovascular disease (CVD) equivalent, clear demonstration that medical interventions should provide primary and secondary CVD risk reduction in diabetic populations, and suggestive evidence that percutaneous coronary revascularization may not provide additive survival benefit to intensive medical management in patients with stable CAD. This additional evidence raises the question of whether documenting asymptomatic atherosclerosis or ischemia in people with diabetes is warranted. More data addressing this issue will be forthcoming from the BARI 2-D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial. Until then, for patients with type 2 diabetes who are asymptomatic for CAD, we recommend that testing for atherosclerosis or ischemia, perhaps with cardiac CT as the initial test, be reserved for those in whom medical treatment goals cannot be met and for selected individuals in whom there is strong clinical suspicion of very-high-risk CAD. Better approaches to identify such individuals based on readily obtained clinical variables are sorely needed.

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confidence: 99%

Screening for Coronary Artery Disease in Patients With Diabetes

et al. 2007

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“…[7][8][9] The role of MPI for detecting ischemia has been validated well and supported by many precedent single-photon emission computed tomography (SPECT) studies. [10][11][12][13] A general consensus has been achieved for detection of ischemia and prognostic evaluation. [3,14] Although abundant data are available in Western countries, few data are available dealing with the role of MPI in Japanese non-diabetic and diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

Nakajima

Yamasaki

Kusuoka

et al. 2009

Eur J Nucl Med Mol Imaging

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Purpose. Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. Methods. A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1mm, urinary albumin excretion of ≥30mg/ g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level and hypertension were enrolled and followed up over a3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Results. Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the one-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 allcause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0-3, 4-8, 9-13 and ≥14 were 0.96, 0.95, 0.82 and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident and electrocardiographic abnormality at rest. Conclusions. The one-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients.

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“…But however patients who are unable to exercise are at increased cardiac risk. The incidence of inducible ischemia is increased in these patients and when present is associated with poor prognosis (Vanzetto et al, 1999). Patients with type 2 diabetes often have multiple cardiac risk factors including hypertension, dyslipidemia, inactivity, smoking and abdominal obesity.…”

Section: Deciding Who To Investigate? Which Are the Patients With Diamentioning

confidence: 99%

“…Accordingly comparisons between myocardial perfusion imaging and stress echocardiography have shown a higher sensitivity for myocardial perfusion imaging for the detection of multivessel and single-vessel coronary artery disease (Schinkel et al, 2003). In asymptomatic diabetic patients the rate of silent myocardial ischemia diagnosed by stress myocardial perfusion imaging ranges from 6 to 59% (Zellweger et al, 2004;Faglia et al, 2002;, De Lorenzo et al, 2002;Wackers et al, 2004;Rajagapolan et al, 2005;Vanzetto et al, 1999;Cosson et al, 2004). This wide range in the prevalence of silent ischemia is related to differences in patient selection, stress methodology and imaging techniques.…”

Section: Nuclear Single Photon Emission Computed Tomography (Spect) Mmentioning

confidence: 99%

Detection of Silent Ischemia in Patients with Type 2 Diabetes

Emilia¹,

Vlad²

2011

Recent Advances in the Pathogenesis, Prevention and Management of Type 2 Diabetes and Its Complications

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Prediction of cardiovascular events in clinically selected high-risk NIDDM patients. Prognostic value of exercise stress test and thallium-201 single-photon emission computed tomography.

Abstract: Inability to exercise and large perfusion defects on thallium-201 scan are major predictors of future death and myocardial infarction in high-risk NIDDM patients.

Cited by 111 publications

References 0 publications

Screening for Coronary Artery Disease in Patients With Diabetes

Screening for Coronary Artery Disease in Patients With Diabetes

Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

Detection of Silent Ischemia in Patients with Type 2 Diabetes

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