title: [Incidence and prognostic value of ischemic heart disease in high risk cardiovascular asymptomatic diabetic patients detected by gated myocardial perfusion SPECT study].
abstract: OBJECTIVE
  To determine the clinical utility of the gated myocardial perfusion SPECT to detect silent ischemia in asymptomatic diabetic patients without previous coronary events and to evaluate the prognosis of this population.
  
  
  METHODS
  A retrospective study of 56 asymptomatic diabetics referred for a gated myocardial perfusion SPECT for diagnosis of ischemic disease was performed. The criteria for ischemia were: mild SDS<4, moderate SDS 4-8, severe SDS>8. A multivariable statistical analysis was carried out to identify possible predictive variables of an abnormal SPECT. The cardiovascular events were recorded up to December-2010.
  
  
  RESULTS
  A high proportion of the 56 patients had an abnormal perfusion study (46.4%), there being moderate-severe ischemia in 10.7%, necrosis with ischemia in 5.4% and necrosis in 7.1%. We found no statistical differences in the type of stress used (treadmill or dipyridamole). The patients had a high combination of cardiovascular risk factors. In the multivariate analysis, diabetic nephropathy was the only factor related to an abnormal SPECT (p=0.043). The events recorded in the follow-up were: 2 early revascularizations, 5 cardiology admissions, 10 non-cardiac related deaths. The existence of ischemia in the SPECT was significantly related to the appearance of cardiovascular events (p<0.05).
  
  
  CONCLUSIONS
  A gated myocardial perfusion SPECT in asymptomatic diabetics with high combination of cardiovascular risk factors detects silent ischemia in a significant proportion and this seems to be related to future coronary events. Diabetic nephropathy implies a greater likelihood of abnormal studies. However, the screening criteria in this population still need to be established for better performance and lower cost.
authors.affiliation: Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, España. richardrua@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Ruano Pérez
authors.forename: F
authors.initials: F
authors.lastname: Gómez-Caminero López
authors.forename: M
authors.initials: M
authors.lastname: Diego Domínguez
authors.forename: A
authors.initials: A
authors.lastname: Martín De Arriba
authors.forename: C
authors.initials: C
authors.lastname: Martín Luengo
authors.forename: J R
authors.initials: JR
authors.lastname: García-Talavera Fernández
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D015897:Comorbidity; D048909:Diabetes Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D004176:Dipyridamole; D005080:Exercise Test; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009336:Necrosis; D009765:Obesity / Q000453:epidemiology; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012907:Smoking / Q000453:epidemiology; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; C078700:technetium tc-99m tetrofosmin; D004176:Dipyridamole