title: Prognostic Value of Normal Perfusion but Impaired Left Ventricular Function in the Diabetic Heart on Quantitative Gated Myocardial Perfusion SPECT.
abstract: OBJECTIVE
  This study aimed at identifying the predictive parameters on quantitative gated myocardial perfusion single-photon emission computed tomography (QG-SPECT) in diabetic patients with normal perfusion but impaired function.
  
  
  METHODS
  Among the 533 consecutive diabetic patients, 379 patients with normal perfusion on rest Tl-201/dipyridamole-stress Tc-99m sestamibi Gated SPECT were enrolled. Patients were grouped into those with normal post-stress left ventricular function (Group I) and those with impaired function (EF <50 or impaired regional wall motion, Group II). We investigated cardiac events and cause of death by chart review and telephone interview. Survival analysis and Cox proportional hazard model analysis were performed.
  
  
  RESULTS
  Between the Group I and II, cardiac events as well as chest pain symptoms, smoking, diabetic complications were significantly different (P < 0.05). On survival analysis, event free survival rate in Group II was significantly lower than in Group I (P = 0.016). In univariate Cox proportional hazard analysis on overall cardiac event, Group (II over I), diabetic nephropathy, summed motion score (SMS), summed systolic thickening score (STS), numbers of abnormal segmental wall motion and systolic thickening predicted more cardiac events (P < 0.05). Multivariate analysis showed that STS was the only independent predictor cardiac event.
  
  
  CONCLUSIONS
  The functional parameter, especially summed systolic thickening score on QG-SPECT had prognostic values, despite normal perfusion, in predicting cardiac events in diabetic patients, and QG-SPECT provides clinically useful risk stratification in diabetic patients with normal perfusion.
authors.affiliation: Department of Nuclear Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute of Chonbuk National University Medical School & Hospital, Jeonju, Jeollabuk-do Korea.
authors.forename: Hwan-Jeong
authors.initials: HJ
authors.lastname: Jeong
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yungun-dong Chongno-gu, Seoul, 110-744 Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yungun-dong Chongno-gu, Seoul, 110-744 Korea.
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute of Chonbuk National University Medical School & Hospital, Jeonju, Jeollabuk-do Korea.
authors.forename: SeHun
authors.initials: S
authors.lastname: Choi
authors.affiliation: Department of Nuclear Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute of Chonbuk National University Medical School & Hospital, Jeonju, Jeollabuk-do Korea.
authors.forename: Yeon-Hee
authors.initials: YH
authors.lastname: Han
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yungun-dong Chongno-gu, Seoul, 110-744 Korea.
authors.forename: June-Key
authors.initials: JK
authors.lastname: Chung
keywords: Diabetes mellitus; Gated myocardial SPECT (Gated SPECT); Prognostic value; Summed systolic thickening score