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Duration and type of therapy for diabetes: Impact on cardiac risk stratification with stress electrocardiographic-gated SPECT myocardial perfusion imaging

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Stress electrocardiogram(ECG)-gated single photon emission computed tomography (SPECT) imaging is highly effective in risk stratification of diabetic patients for adverse cardiac events. While patients with diabetes are predisposed to a more aggressive progression of vascular disease, the impact of its duration and type of therapy on risk stratification are unknown.

Methods

From the Hartford Hospital Nuclear Cardiology clinical database, 886 diabetic patients who underwent exercise or pharmacologic stress ECG-gated SPECT were identified, with complete follow-up regarding the occurrence of adverse cardiac events and information regarding the duration of diabetes and the type of therapy (insulin vs oral medication only) at the time of testing. Images were interpreted using the American College of Cardiology/ASNC standard 17-segment scoring model.

Results

Of the 886 diabetic patients, 98 (11%) suffered cardiac death or non-fatal myocardial infarction during follow-up (2.5 ± 1.6 years). A receiver operator characteristics curve demonstrated that diabetes ≥10 years in duration provided the maximal sum of sensitivity and specificity for the prediction of adverse cardiac outcomes. Multivariate analysis identified the following as independent predictors of adverse outcome: Post-stress ejection fraction (EF) <40% (P = .001), age (P = .004), insulin therapy (P = .031), diabetes duration >10 years (P = .038), summed stress score (SSS) >8 (P = .046). For patients with an SSS >8, diabetes duration and type of therapy significantly enhanced risk stratification. Similar findings emerged for patients with a post-stress EF <40%.

Conclusion

For diabetic patients undergoing stress ECG-gated SPECT myocardial perfusion imaging, disease duration and type of therapy provide independent and incremental prognostic information. Integration of these variables with this cardiovascular imaging technology significantly enhances cardiac risk stratification.

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Authors and Affiliations

  1. Cardiology Division, Nuclear Cardiology Laboratory, Henry Low Heart Center, Hartford Hospital, 80 m Seymour Street, Hartford, CT, 06102, USA

    Dimitrios Barmpouletos MD, Gerasimos Stavens MD, Alan W. Ahlberg MA, Deborah M. Katten RN, MPH, David M. O’Sullivan PhD & Gary V. Heller MD, PhD

  2. University of Connecticut School of Medicine, Farmington, CT, USA

    Dimitrios Barmpouletos MD

Authors
  1. Dimitrios Barmpouletos MD
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  2. Gerasimos Stavens MD
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  3. Alan W. Ahlberg MA
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  4. Deborah M. Katten RN, MPH
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  5. David M. O’Sullivan PhD
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  6. Gary V. Heller MD, PhD
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Corresponding author

Correspondence to Gary V. Heller MD, PhD.

Additional information

See related editorial, doi:10.1007/s12350-010-9306-3.

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Barmpouletos, D., Stavens, G., Ahlberg, A.W. et al. Duration and type of therapy for diabetes: Impact on cardiac risk stratification with stress electrocardiographic-gated SPECT myocardial perfusion imaging. J. Nucl. Cardiol. 17, 1041–1049 (2010). https://doi.org/10.1007/s12350-010-9293-4

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  • DOI: https://doi.org/10.1007/s12350-010-9293-4

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