Myocardial perfusion scintigraphy in asymptomatic diabetic patients: a critical review.
The increasing prevalence of diabetes mellitus and the associated high cardiovascular risk has made the non-invasive identification of silent coronary heart disease in diabetic individuals an important issue. This strategy could identify higher risk asymptomatic patients with diabetes mellitus in whom coronary revascularization may improve the outcome beyond that achieved by currently recommended medical management. Stress myocardial perfusion imaging has been shown to be effective in detecting coronary heart disease and predicting adverse cardiac events in asymptomatic diabetic patients. However, the clinical utility of myocardial perfusion scintigraphy is debated intensively due to the paucity of prospective and outcome based evidence. The controversy stems from several observational studies, epidemiologic data and cost-effectiveness analyses. Thus, although several authors and professional organizations advocate the use of stress imaging for screening higher risk asymptomatic diabetic patients, others are cautious in recommending any kind of stress testing in that population. This review is based on a broad survey of the literature and discusses the potential role of stress myocardial perfusion scintigraphy in screening asymptomatic diabetic subjects for coronary heart disease in the current era and in relation with other non-invasive screening tools.
Moralidis
E
E
Department of Nuclear Medicine, AHEPA Hospital, Aristotle University Medical School, Thessaloniki, Greece. emoral@hol.gr
Didangelos
T
T
Arsos
G
G
Athyros
V
V
Mikhailidis
D P
DP
D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D055414:Myocardial Perfusion Imaging / Q000191:economics; D012307:Risk Factors