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Risk stratification among diabetic patients undergoing stress myocardial perfusion imaging

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Previous studies have suggested that diabetic patients undergoing single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) are at greater risk for cardiac events than non-diabetic patients with both normal and abnormal imaging results. However, the impact of stress modality on outcomes in this patient group has not been examined.

Methods

The data on all patients undergoing exercise stress or vasodilator stress SPECT MPI from 1996 to 2005 were reviewed. After excluding patients based on our predefined criteria, we subcategorized the study population into diabetic patients and non-diabetic patients. Among the diabetic patients, we identified patients with known coronary artery disease (CAD) and no known CAD. All studies were interpreted using the 17-segment ASNC model. The presence, extent, and severity of perfusion defects were calculated using the summed stress score (SSS), and patients were classified into normal (SSS < 4), mildly abnormal (SSS 4-8), and moderate-severely abnormal (SSS > 8) categories. The annualized cardiac event rate including cardiac death and non-fatal myocardial infarction was calculated over a mean follow-up period of 2.4 ± 1.4 years with a maximum of 6 years.

Results

The cardiac event rate was statistically significantly lower in diabetic patients undergoing exercise stress MPI when compared to the diabetic patients undergoing pharmacological stress MPI across all three perfusion categories (1.3% vs 3.4%, 2.3% vs 5.7%, 4.2% vs 10.7%, respectively). Diabetic patients with no known CAD, who underwent exercise stress MPI had significantly lower cardiac events across all three perfusion categories as compared to the remainder of the diabetic population. Ability to perform exercise stress test was the strongest multivariate predictor of favorable outcome, whereas ejection fraction < 50%, abnormal perfusion imaging on SPECT MPI, and increasing age stood out as independent predictors of adverse outcome in the diabetic patients. Within the abnormal perfusion category, the annualized cardiac event rate among patients undergoing exercise stress SPECT MPI was not statistically different between the diabetic and non-diabetic cohorts.

Conclusion

Diabetic patients undergoing exercise SPECT MPI have a significantly better prognosis than those undergoing pharmacological stress, more similar to patients without diabetes. In patients with diabetes exercise stress test MPI identifies low risk patients and provides precise risk stratification.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, Miami, FL, 33136, USA

    Abhijit Ghatak MD, MRCP

  2. Nuclear Cardiology Laboratory, Hartford Hospital, Hartford, CT, USA

    Santosh Padala MD & Deborah M. Katten RN, MPH

  3. Division of Cardiology, Brigham and Women’s Hospital, Boston, MA, USA

    Donna M. Polk MD, MPH

  4. University of Connecticut Health Center, Farmington, CT, USA

    Santosh Padala MD & Gary V. Heller MD, PhD

Authors
  1. Abhijit Ghatak MD, MRCP
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  2. Santosh Padala MD
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  3. Deborah M. Katten RN, MPH
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  4. Donna M. Polk MD, MPH
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  5. Gary V. Heller MD, PhD
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Correspondence to Abhijit Ghatak MD, MRCP.

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Ghatak, A., Padala, S., Katten, D.M. et al. Risk stratification among diabetic patients undergoing stress myocardial perfusion imaging. J. Nucl. Cardiol. 20, 529–538 (2013). https://doi.org/10.1007/s12350-013-9731-1

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  • DOI: https://doi.org/10.1007/s12350-013-9731-1

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