title: Combined assessment of myocardial perfusion and function by ECG-gated myocardial perfusion single-photon emission computed tomography for the prediction of future cardiac events in patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  The mid-term prognostic significance of ECG-gated single-photon emission computed tomography (SPECT) remains unclear in Japanese patients with type 2 diabetes mellitus (DM). In the present study rates of future cardiac events (nonfatal acute myocardial infarction (AMI), cardiac death (CD) and severe heart failure (HF) requiring hospitalization) were compared in patients with and without DM.
  
  
  RESULTS
  1,810 patients (563 DM and 1,247 non-DM) we followed for a mean of 26.3±15.5 months. Summed stress score (SSS), summed difference score (SDS), poststress ejection fraction (EF) and resting end-diastolic volume (EDV) were calculated. In total, 20 cases of AMI (9 in DM (1.59%) and 11 in non-DM (0.88%)), 20 of CD (7 in DM patients (1.24%) and 13 in non-DM (1.04%)) and 54 of severe HF (31 in DM (5.5%) and 23 in non-DM (1.84%)) occurred. Univariate Cox analysis showed that, in DM patients, predictors of total cardiac events were poststress EF (Wald 60.4; P<0.001), resting EDV (Wald 53.8; P<0.001), SSS (Wald 39.6; P<0.001), SDS (Wald 26.1; P<0.001), history of prior MI (Wald 4.32; P<0.05) and hemoglobin A(1c) value (Wald 4.30; P<0.05). Multivariate Cox analysis showed that poststress EF (Wald 9.85; P<0.01) and SDS (Wald 6.19; P<0.01) were independent predictors of total cardiac events.
  
  
  CONCLUSIONS
  Combined assessment of perfusion and function by ECG-gated SPECT may predict future cardiac events in type 2 DM patients.
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kato
authors.forename: Naoya
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Yoshimochi
authors.initials: Y
authors.lastname: Nakano
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Shunichi
authors.initials: S
authors.lastname: Yoda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.forename: Shu
authors.initials: S
authors.lastname: Kasama
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D003643:Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D055414:Myocardial Perfusion Imaging; D016016:Proportional Hazards Models; D011446:Prospective Studies