Prognostic Value of ¹²³I-Betamethyl-p-Iodophenyl-Pentadecanoic Acid Single-Photon Emission Computed Tomography in Diabetic Patients With Suspected Ischemic Heart Disease

Abstract

Background: Because of their high risk for cardiovascular events, we investigated the role of 123 I-betamethyl-piodophenyl-pentadecanoic acid (BMIPP) SPECT in evaluating the prognosis of diabetic patients with suspected coronary heart disease. Methods and Results:We retrospectively registered 186 diabetic patients with suspected coronary heart disease, but no previous diagnosis of heart disease, who had been examined by BMIPP and thallium (TL) dual SPECT. They were followed for over 2 years. The dual SPECT images were scored to obtain summed defect scores for each SPECT image (BMDS, TLDS and mismatch score [MS]). The primary endpoint was the first incidence of all-cause cardiac events. The secondary endpoint was cardiac death. Clinical classical risk factors in addition to the stage of chronic kidney disease (CKD), as well as cardiac function, were included in the prognostic analysis. Cardiac events occurred in 39 patients, including 8 cardiac deaths. Kaplan-Meier analysis revealed significantly more frequent cardiac event rates in patients with than without MS ≥5 or BMDS ≥6 (P<0.0001). Cox hazard multivariate analysis showed that MS and CKD stage or BMIPP and CKD stage were independent predictors. Only hemodialysis was a significant prognostic indicator for cardiac death.Conclusions: BMIPP SPECT when combined with CKD stage accurately predicts cardiac events among diabetic patients with suspected ischemic heart disease. (Circ J 2012; 76: 2633 - 2639

Diagnosis and Detection of Myocardial Injury in Active Cardiac Sarcoidosis – Significance of Myocardial Fatty Acid Metabolism and Myocardial Perfusion Mismatch –

“…Summed mismatch score (sumMS) was obtained as the sum of each mismatch score in the 17 segments as shown in our previous study. 18 Cardiac function was assessed on quantitative gated TL-SPECT to generate LV ejection fraction (LVEF; %) and enddiastolic volume (EDV; ml). For CMR images, LGE pattern was classified as subepicardial, midwall, subendocardial and transmural types.…”

“…Non-invasive cardiac imaging has recently been developed: cardiac magnetic resonance (CMR) and 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) were added to the Japanese Ministry of Health and Welfare (JMHW) modified diagnostic criteria for CS in 2006. 4 With regard to FDG-PET, however, physiological myocardial FDG uptake was a critical drawback for the diagnosis of CS.…”

Significance of worsening renal function and nuclear cardiology for predicting cardiac death in patients with known or suspected coronary artery disease

“…The SPECT images were divided into 20 segments [12] on three short-axis (distal, mid, basal) and one vertical long-axis (mid) slices, and the tracer uptake of each segment was visually scored using a 5-point scale (normal, slight, moderate, and severe reduction of uptake, 0, 1, 2 and 3, respectively; absent uptake, 4) [18]. The sum total of the scores of 20 segments in the stress and rest images provided the SSS and the summed rest score (SRS), respectively.…”

Comparison of the Framingham Risk Score, UK Prospective Diabetes Study (UKPDS) Risk Engine, Japanese Atherosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC) and Maximum Carotid Intima-Media Thickness for Predicting Coronary Artery Stenosis in Patients with Asymptomatic Type 2 Diabetes

“…Therefore, these subjects may benefit from additional noninvasive tests, such as measurement of the max-IMT. The addition of max-IMT measurementscanbeusedtoidentifyhigh-risksubjects,especiallythosewithlowriskscores,whoshouldundergo exercise stress testing, single photon emission computed tomography or CCTA and may be managed withintensivelifestylemodificationandmedicaltherapy, particularly aggressive lipid-lowering treatment 29,30) . Thepresentdataalsosuggestthatthemax-IMThasa threshold for the prediction of CAS in combination witheachofthethreeriskscores,astheprevalenceof CAS clearly increased between the lowest tertile and middletertileandwassimilarbetweenthemiddletertile and highest tertile in the max-IMT category.…”