title: Myocardial perfusion imaging and cardiac events in a cohort of asymptomatic patients with diabetes living in southern France.
abstract: OBJECTIVE
  To assess the association between abnormal stress myocardial perfusion imaging (MPI) and cardiac events (CE) in asymptomatic patients with diabetes and with > or = 1 additional risk factor. Predictors of abnormal stress MPI were also evaluated.
  
  
  METHODS
  Four hundred and forty-seven consecutive patients who underwent stress MPI were prospectively followed for 2.1 [0.5-4.1] years for the subsequent occurrence of hard CE (myocardial infarction and sudden or coronary death) and soft CE (unstable angina and ischaemic heart failure requiring hospitalization). Re-vascularization procedures performed as a result of the screening protocol were not included in the analysis.
  
  
  RESULTS
  Follow-up was successful in 419 of 447 patients (94%), of whom 71 had abnormal MPI at baseline. Medical therapy was intensified in all subjects and especially in those with abnormal MPI. Twenty-three patients with abnormal MPI underwent a re-vascularization procedure. CEs occurred in 14 patients, including six of 71 patients (8.5%) with abnormal MPI and eight of 348 patients (2.3%) with normal MPI (P < 0.005). Only two patients developed a hard CE and 12 a soft CE. In multivariate analysis, abnormal MPI was the strongest predictor for CEs [odds ratio (OR) (95% CI) = 5.6 (1.7-18.5)]. Low-density lipoprotein cholesterol > or = 3.35 mmol/l [OR (95% CI) = 7.3; 1.5-34.7] and age > median [OR (95% CI) = 6.0 (1.2-28.6)] were additional independent predictors for CE. The independent predictors for abnormal MPI were male gender, plasma triglycerides > or = 1.70 mmol/l, creatinine clearance < 60 ml/min and HbA1c > 8%, with male gender the strongest [OR (95% CI) = 4.0 (1.8-8.8)].
  
  
  CONCLUSIONS
  Asymptomatic patients with diabetes in this study had a very low hard cardiac event rate over an intermediate period. This could be explained by the effects of intervention or by the low event rate in the background population. Randomized studies of cardiac heart disease screening are required in asymptomatic subjects with diabetes to determine the effectiveness of this intervention.
authors.affiliation: Metabolic Diseases Department, Montpellier University Hospital, Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Sultan
authors.forename: C
authors.initials: C
authors.lastname: Piot
authors.forename: D
authors.initials: D
authors.lastname: Mariano-Goulart
authors.forename: J P
authors.initials: JP
authors.lastname: Daures
authors.forename: F
authors.initials: F
authors.lastname: Comte
authors.forename: E
authors.initials: E
authors.lastname: Renard
authors.forename: A
authors.initials: A
authors.lastname: Avignon
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging*; D004176:Dipyridamole; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005602:France; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000175:diagnosis; D011379:Prognosis; D011446:Prospective Studies; D015635:Radionuclide Ventriculography; D019275:Radiopharmaceuticals; D012306:Risk; D012737:Sex Factors; D017256:Technetium Tc 99m Sestamibi; D014665:Vasodilator Agents
chemical_list: D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi