title: Silent myocardial ischemia detected by single photon emission computed tomography (SPECT) and risk of cardiac events among asymptomatic patients with type 2 diabetes: a meta-analysis of prospective studies.
abstract: OBJECTIVE
  To assess the value of detecting silent myocardial ischemia (SMI) by single photon emission computed tomography (SPECT) in predicting risk of cardiac events among patients with type 2 diabetes mellitus (T2DM) who do not have overt cardiac symptoms.
  
  
  METHODS
  Electronic databases (PubMed, Cochrane Library, EMBASE, and others) and original article references were systematically searched through February 1, 2013. A fixed-effects model was applied to pooled data to estimate relative risks (RR) and 95% confidence intervals (CI).
  
  
  RESULTS
  Ten prospective studies with follow-up ranging from 1 to 6 years were identified. Among the total of 1360 asymptomatic patients with T2DM screened by SPECT, the cumulative prevalence rate of SMI was 26.1%. Patients with SMI were at increased risk of experiencing endpoints relative to patients without SMI: RR (95% CI) for cardiac death, 4.60 (1.78-11.84); non-fatal cardiac events, 3.48 (2.30-5.28); total cardiac events, 3.48 (2.59-4.68); and all-cause mortality, 2.20 (1.14-4.25). The risk of cardiac death and non-fatal cardiac events increased with increasing severity of SPECT-detected abnormalities.
  
  
  CONCLUSIONS
  SMI detected by SPECT is associated with increased risk of cardiac death, all-cause mortality, and non-fatal cardiac events in T2DM patients without overt cardiac symptoms. Advanced intervention procedures including intensive drug management should be implemented to reduce the risk of cardiac events for SMI-positive T2DM patients.
authors: Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China; Department of Geriatrics, The First Affiliated Hospital, Kunming Medical University, Kunming, China.
authors: Lihua
authors: L
authors: Zhang
authors: Department of Endocrinology and Metabolism, The First Affiliated Hospital, Kunming Medical University, Kunming, China.
authors: Hong
authors: H
authors: Li
authors: Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
authors: Simin
authors: S
authors: Zhang
authors: Department of Nutrition, The University of North Carolina, Chapel Hill, NC, USA.
authors: Lindsay M
authors: LM
authors: Jaacks
authors: Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
authors: Yufeng
authors: Y
authors: Li
authors: Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China. Electronic address: jiln@bjmu.edu.cn.
authors: Linong
authors: L
authors: Ji
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Meta-analysis; Silent myocardial ischemia; Single photon emission computed tomography (SPECT); Type 2 diabetes