title: Detection of myocardial microvascular disease using contrast echocardiography during adenosine stress in type 2 diabetes mellitus: prospective comparison with single-photon emission computed tomography.
abstract: OBJECTIVE
  To evaluate myocardial microvascular disease in patients with type 2 diabetes mellitus (DM) using myocardial contrast echocardiography (MCE) and to report on its diagnostic accuracy using single photon emission tomography (SPECT) as reference test.
  
  
  METHODS
  We prospectively enrolled 79 patients (25 DM; 66 ±11 years) who underwent simultaneous SPECT and MCE with contrast agent during adenosine stress. MCE and SPECT were visually analyzed using 17 segments. Quantitative MCE parameters were derived from replenishment curves. Microbubble velocity (β min(-1)), absolute myocardial blood flow (MBF ml/min/g), and reserve values were calculated. Diagnostic accuracy and area under curve (AUC) was reported.
  
  
  RESULTS
  Patients with DM had higher BMI vs non DM (33±7 vs 28±5kg/m(2) P=0 .007), with more prior myocardial infarction (40 vs 15% P=.01). Visual MCE was abnormal in 40 (51%) patients (60% in DM vs 46% in non DM P=0.04). SPECT was abnormal in 38 (48%) patients [60% in DM vs 42% non DM, P=0.01]. Reserve parameters were lower in DM vs. non DM patients: (β 1.77±1.12 vs 2.20±1.4, P<0.001 and MBF 2.86± 2.62 vs. 3.67±2.84, P<0.001). DM patients without CAD on SPECT had significantly lower β, and MBF reserve compared to non DM patients without CAD. Compared to SPECT, β reserve cutoff 1.6 had AUC 0.817, sensitivity 81%, and specificity 66% while MBF reserve cutoff 1.9 had AUC 0.760, sensitivity 79%, and specificity 63% in DM patients.
  
  
  CONCLUSIONS
  Diabetes is associated with myocardial microvascular abnormalities as evidenced by abnormal myocardial perfusion on visual and quantitative MCE.
authors.affiliation: Mayo Clinic, Division of Cardiovascular Diseases and Internal Medicine, MN 55905, USA.
authors.forename: Sahar S
authors.initials: SS
authors.lastname: Abdelmoneim
authors.forename: Ananda
authors.initials: A
authors.lastname: Basu
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bernier
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Dhoble
authors.forename: Samir S
authors.initials: SS
authors.lastname: Abdel-Kader
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Mulvagh
mesh_terms: D000241:Adenosine; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D008910:Minnesota; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D003287:Contrast Media; D000241:Adenosine