Prevalence of symptomatic and silent stress-induced perfusion defects in diabetic patients with suspected coronary artery disease referred for myocardial perfusion scintigraphy.

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Serval ID
serval:BIB_423CDF26E92E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prevalence of symptomatic and silent stress-induced perfusion defects in diabetic patients with suspected coronary artery disease referred for myocardial perfusion scintigraphy.
Journal
European journal of nuclear medicine and molecular imaging
Author(s)
Prior J.O., Monbaron D., Koehli M., Calcagni M.L., Ruiz J., Bischof Delaloye A.
ISSN
1619-7070
Publication state
Published
Issued date
2005
Peer-reviewed
Oui
Volume
32
Number
1
Pages
60-9
Language
english
Notes
Publication types: Clinical Trial ; Controlled Clinical Trial ; Journal Article - Publication Status: ppublish
Abstract
PURPOSE: Silent myocardial ischaemia--as evaluated by stress-induced perfusion defects on myocardial perfusion scintigraphy (MPS) in patients without a history of chest pain--is frequent in diabetes and is associated with increased rates of cardiovascular events. Its prevalence has been determined in asymptomatic diabetic patients, but remains largely unknown in diabetic patients with suspected coronary artery disease (CAD) in the clinical setting. In this study we therefore sought (a) to determine the prevalence of symptomatic and silent perfusion defects in diabetic patients with suspected CAD and (b) to characterise the eventual predictors of abnormal perfusion. METHODS: The patient population comprised 133 consecutive diabetic patients with suspected CAD who had been referred for MPS. Studies were performed with exercise (41%) or pharmacological stress testing (1-day protocol, (99m)Tc-sestamibi, 201Tl or both). We used semi-quantitative analysis (20-segment polar maps) to derive the summed stress score (SSS) and the summed difference score (SDS). RESULTS: Abnormal MPS (SSS> or =4) was observed in 49 (37%) patients (SSS=4.9+/-8.4, SDS=2.4+/-4.7), reversible perfusion defects (SDS> or =2) in 40 (30%) patients [SSS=13.3+/-10.9; SDS=8.0+/-5.6; 20% moderate to severe (SDS>4), 7% multivessel] and fixed defects in 21 (16%) patients. Results were comparable between patients with and patients without a history of chest pain. Of 75 patients without a history of chest pain, 23 (31%, 95% CI=21-42%) presented reversible defects (SSS=13.9+/-11.3; SDS=7.4+/-1.2), indicative of silent ischaemia. Reversible defects were associated with inducible ST segment depression during MPS stress [odds ratio (OR)=3.2, p<0.01). Fixed defects were associated with erectile dysfunction in males (OR=3.7, p=0.02) and lower aspirin use (OR=0.25, p=0.02). CONCLUSION: Silent stress-induced perfusion defects occurred in 31% of the patients, a rate similar to that in patients with a history of chest pain. MPS could identify these patients with a potentially increased risk of cardiovascular events.
Keywords
Adult, Aged, Aged, 80 and over, Causality, Comorbidity, Coronary Artery Disease, Diabetes Mellitus, Exercise Test, Female, Humans, Incidence, Male, Middle Aged, Myocardial Ischemia, Prevalence, Prognosis, Radiopharmaceuticals, Reproducibility of Results, Risk Assessment, Risk Factors, Sensitivity and Specificity, Switzerland, Technetium Tc 99m Sestamibi
Pubmed
Web of science
Open Access
Yes
Create date
25/01/2008 12:22
Last modification date
01/10/2019 7:17
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