title: Changes in ischaemia as assessed with single-photon emission computed tomography myocardial perfusion imaging in high-risk patients with diabetes without cardiac symptoms: relation with coronary atherosclerosis on computed tomography coronary angiography.
abstract: OBJECTIVE
  The study aims (i) to evaluate changes in myocardial ischaemia on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) after 2 years in a cohort of high-risk patients with diabetes without cardiac symptoms or known coronary artery disease (CAD) and (ii) to assess the value of baseline computed tomography coronary angiography (CTA)-derived coronary atherosclerosis parameters to predict changes in myocardial ischaemia.
  
  
  RESULTS
  The population consisted of 100 high-risk patients with diabetes without cardiac symptoms referred for cardiovascular risk stratification. All patients underwent coronary artery calcium (CAC) scoring, CTA, and SPECT MPI. After 2 years of follow-up, SPECT MPI was repeated to evaluate potential progression of ischaemia.In total, 20% of patients presented with ischaemia at baseline. Of these 20 patients, 7 (35%) still had ischaemia at follow-up, whereas 13 (65%) showed resolution and 4 (20%) showed progression of ischaemia at follow-up. Of the 80 patients without ischaemia at baseline, 65 (81%) had a normal MPI at follow-up and 15 patients (19%) presented with new ischaemia. There were no significant differences in the CAC score or the extent, severity, and composition of CAD on CTA between patients with and without ischaemia at baseline. Similarly, no differences could be demonstrated between patients with and without ischaemia at follow-up or between patients with and without progression of ischaemia.
  
  
  CONCLUSIONS
  The rate of progression of ischaemia in high-risk patients with diabetes without cardiac symptoms is limited. Few patients presented with new ischaemia, whereas some patients showed resolution of ischaemia. Atherosclerosis parameters on CTA were not predictive of new-onset ischaemia or progression of ischaemia.
authors: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors: Michiel A
authors: MA
authors: de Graaf
authors: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors: Cornelis J
authors: CJ
authors: Roos
authors: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
authors: Josanne M
authors: JM
authors: Mansveld
authors: Department of Internal Medicine, Westeinde Hospital, The Hague, The Netherlands.
authors: Aan V
authors: AV
authors: Kharagjitsingh
authors: Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors: Petra
authors: P
authors: Dibbets-Schneider
authors: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Lucia J
authors: LJ
authors: Kroft
authors: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors: J Wouter
authors: JW
authors: Jukema
authors: Department of Radiology, Division of Nuclear Medicine, The University of Michigan Medical Center, Ann Arbor, MI, USA.
authors: Edward P
authors: EP
authors: Ficaro
authors: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
authors: Jeroen J
authors: JJ
authors: Bax
authors: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands a.j.h.a.scholte@lumc.nl.
authors: Arthur J
authors: AJ
authors: Scholte
mesh_terms: D055424:Cardiac-Gated Imaging Techniques; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D048909:Diabetes Complications / Q000000981:diagnostic imaging*; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging; D011857:Radiographic Image Interpretation, Computer-Assisted; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: SPECT MPI; coronary CTA; coronary atherosclerosis; diabetes mellitus; myocardial ischaemia