Cardiac outcomes 3 years after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: value of myocardial perfusion imaging and coronary calcium score.
OBJECTIVE
The aim of the study was to identify the possible association among myocardial perfusion imaging (MPI) variables, coronary calcium score (CCS), and adverse events at medium term in type 2 asymptomatic diabetes mellitus patients.


METHODS
Patients who participated in a first study that included a stress-rest MPI and a CCS assessment were asked to take part in this study. The present study protocol required a control single-photon emission computerized tomography after 3 years. Forty-one patients gave their informed consent.


RESULTS
Of the 41 patients, 13 (32%) showed perfusion defects at the initial MPI. Of them, at 3 years, five continued showing perfusion defects, whereas another two had new defects (incidence of ischemia of 17%). Thus, 61% of the initial positive MPIs were normal at 3 years (P=0.04). In these cases the therapy was modified between the two studies. Left ventricular ejection fraction at stress showed a slight increase at 3 years (P=NS). Ventricular volumes significantly decreased at 3 years (P<0.01). Three patients (7.3%) developed an event during the follow-up (FU): two noncardiac deaths and one non-ST elevation myocardial infarction. The only variables that showed a possible association with the occurrence of events at FU were a CCS higher than 100 and less than 5 metabolic equivalents (METS) reached during the stress test (P=0.01).


CONCLUSIONS
A CCS higher than 100 and a low functional capacity (<5 METS), but not an abnormal MPI, can be associated with cardiac events at 3-year FU in asymptomatic type 2 diabetic patients.
aInstitute of Cardiology bInstitute of Endocrinology, La Habana, Cuba cNuclear Medicine Section, International Atomic Energy Agency (IAEA), Vienna, Austria.
Amalia
A
Peix
Lázaro O
LO
Cabrera
Lydia
L
Rodríguez
Kenia
K
Padrón
José
J
Llanes
Manuel
M
Licea
Ivette
I
Castillo
Yaquelin
Y
Rodríguez
Regla
R
Carrillo
Erick
E
Mena
Yoel
Y
Fernández
Maurizio
M
Dondi
Diana
D
Páez
D058070:Asymptomatic Diseases; D002118:Calcium / Q000378:metabolism*; D055424:Cardiac-Gated Imaging Techniques; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D013312:Stress, Physiological
D002118:Calcium