Reclassification of cardiovascular risk by myocardial perfusion imaging in diabetic patients with abnormal resting electrocardiogram.
OBJECTIVE
Despite an extensive use of stress myocardial perfusion single-photon emission computed tomography (MPS), no study addressed the role of perfusion imaging in diabetic patients with abnormal resting electrocardiogram (ECG). We compared analytical approaches to assess the added value of stress MPS variables in estimating coronary heart disease outcomes in diabetic patients with abnormal resting ECG.


RESULTS
A total of 416 patients with diabetes and abnormal resting ECG who underwent stress MPS were prospectively followed up after the index study. The end point was the occurrence of a major cardiac event, including cardiac death and nonfatal myocardial infarction. At the end of follow-up (median 58 months), 42 patients experienced events. MPS data increased the predictive value of a model including traditional cardiovascular risk factors and left ventricular (LV) ejection fraction (likelihood ratio χ² from 17.54 to 24.15, p < 0.05, with a C statistic of 0.72, 95% confidence interval: 0.65-0.79). The addition of MPS data resulted in reclassification of 25% of the sample with a net reclassification improvement of 0.20 (95% confidence interval: 0.05-0.36). Overall, 63 patients were reclassified to a lower risk category, with a 5-year event rate of 3.5%, and 40 patients were reclassified to a higher risk category, with a 5-year event rate of 20%.


CONCLUSIONS
The addition of MPS findings to a model based on traditional cardiovascular risk factors and LV ejection fraction improves risk classification for incident cardiac events in diabetic patients with abnormal resting ECG.
Department of Translational Medical Sciences, University Federico II, Naples, Italy.
M
M
Petretta
Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
W
W
Acampa
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
L
L
Evangelista
Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
S
S
Daniele
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
E
E
Zampella
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
R
R
Assante
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
C
C
Nappi
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
V
V
Cantoni
SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy.
G
G
Fiumara
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy. Electronic address: cuocolo@unina.it.
A
A
Cuocolo
D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012307:Risk Factors; D013312:Stress, Physiological; D013318:Stroke Volume; D017256:Technetium Tc 99m Sestamibi; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
Inducible ischemia; Myocardial perfusion imaging; Prognosis; Type 2 diabetes