title: Abnormal myocardial perfusion and risk of heart failure in patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  Diabetes is a major risk factor for heart failure (HF), although the pathophysiological processes have not been clarified.
  
  
  OBJECTIVE
  To determine the prevalence of HF and of abnormal myocardial perfusion in diabetic patients evaluated using technetium (99m) sestamibi single-photon emission computed tomography.
  
  
  METHODS
  An observational cross-sectional study was conducted that included patients with type 2 diabetes mellitus who underwent echocardiography to diagnose HF and a pharmacological stress test with intravenous dipyridamole to examine cardiac scintigraphic perfusion abnormalities. Clinical and biochemical data were also collected.
  
  
  RESULTS
  Of the 160 diabetic patients included, 92 (57.6%) were in HF and 68 (42.5%) were not. When patients were stratified according to the presence of abnormal myocardial perfusion, those with abnormal perfusion had a higher prevalence of HF (93%) than those with normal perfusion (44.4%) (P<0.0001). Patients with HF weighed more (P=0.03), used insulin less frequently (P=0.01), had lower total cholesterol (P=0.05) and high-density lipoprotein cholesterol concentrations (P=0.002), and a greater number of their myocardial segments showed abnormal perfusion (P≤0.001). More HF patients had a history of myocardial infarction (P<0.001) compared with those without HF. In a logistic regression analysis, the number of segments exhibiting abnormal myocardial perfusion was an independent risk factor for HF.
  
  
  CONCLUSIONS
  The prevalence of HF in diabetic patients was high and HF predominantly occured in association with myocardial ischemia.
authors.affiliation: HF Clinic, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán".
authors.forename: Marcelo
authors.initials: M
authors.lastname: Utrera-Lagunas
authors.forename: Arturo
authors.initials: A
authors.lastname: Orea-Tejeda
authors.forename: Lilia
authors.initials: L
authors.lastname: Castillo-Martínez
authors.forename: Karla
authors.initials: K
authors.lastname: Balderas-Muñoz
authors.forename: Candace
authors.initials: C
authors.lastname: Keirns-Davis
authors.forename: Sarahi
authors.initials: S
authors.lastname: Espinoza-Rosas
authors.forename: Néstor Alonso
authors.initials: NA
authors.lastname: Sánchez-Ortíz
authors.forename: Gabriela
authors.initials: G
authors.lastname: Olvera-Mayorga
keywords: Diabetes mellitus; Heart failure; Myocardial perfusion