Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with diabetes mellitus and these patients have an elevated prevalence of silent myocardial ischemia. Aim of this study was to assess the prevalence of inducible ischemia by sestamibi SPECT in patients with diabetes and suspected or known CAD.Material and Methods: Between December 2003 and September 2004, 758 consecutive patients (282 women and 476 men, mean age 63±9 years), with at least a five-year history of diabetes mellitus were unrolled in an ongoing multi-center trial. All patients underwent rest and stress sestamibi SPECT imaging with physical exercise (n=346) or dipyridamole (n=412) (0.142 mg/kg/min intravenous over 4 minutes). SPECT studies were interpreted by two independent observers utilizing a 20-segment scoring system to determine summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS). SPECT studies with a SRS or SSS>3 were considered abnormal. The SDS was used to determine the presence of inducible ischemia and to assess the extent and severity of perfusion defects. Patients without history of CAD were referred for SPECT imaging for recurrence of atypical symptoms, for risk assessment before general surgery, or for screening of CAD due to presence of multiple cardiac risk factors.Results: 290 patients (38% of the total) had documented CAD, while 468 (62%) patients had no history of CAD or evidence of previous myocardial infarction on ECG. Among patients with CAD, 104 (36%) were symptomatic and 186 (64%) were symptom-free. Among patients without CAD, 200 (43%) were symptomatic and 268 (57%) were symptoms-free. Inducible ischemia at SPECT was detected in 69% of the patients with CAD and in 50% of the patients without CAD. The prevalence of ischemia was not different in symptomatic and symptom-free patients in both groups of patients with (63% and 75%, respectively, p=NS) and without CAD (49% and 51% respectively, p=NS). In both groups of patients with or without CAD, the extent and the severity of ischemia was not related to symptoms status, considering that SDS were not different between patients with and without symptoms.
A Prospective, Multi-Center Trial to Identify the Prevalence of Inducible Ischemia in Patients Presenting with Diabetes and Suspected or Known Coronary Artery Disease: Preliminary Results
CITTANTI, Corrado;
2005
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with diabetes mellitus and these patients have an elevated prevalence of silent myocardial ischemia. Aim of this study was to assess the prevalence of inducible ischemia by sestamibi SPECT in patients with diabetes and suspected or known CAD.Material and Methods: Between December 2003 and September 2004, 758 consecutive patients (282 women and 476 men, mean age 63±9 years), with at least a five-year history of diabetes mellitus were unrolled in an ongoing multi-center trial. All patients underwent rest and stress sestamibi SPECT imaging with physical exercise (n=346) or dipyridamole (n=412) (0.142 mg/kg/min intravenous over 4 minutes). SPECT studies were interpreted by two independent observers utilizing a 20-segment scoring system to determine summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS). SPECT studies with a SRS or SSS>3 were considered abnormal. The SDS was used to determine the presence of inducible ischemia and to assess the extent and severity of perfusion defects. Patients without history of CAD were referred for SPECT imaging for recurrence of atypical symptoms, for risk assessment before general surgery, or for screening of CAD due to presence of multiple cardiac risk factors.Results: 290 patients (38% of the total) had documented CAD, while 468 (62%) patients had no history of CAD or evidence of previous myocardial infarction on ECG. Among patients with CAD, 104 (36%) were symptomatic and 186 (64%) were symptom-free. Among patients without CAD, 200 (43%) were symptomatic and 268 (57%) were symptoms-free. Inducible ischemia at SPECT was detected in 69% of the patients with CAD and in 50% of the patients without CAD. The prevalence of ischemia was not different in symptomatic and symptom-free patients in both groups of patients with (63% and 75%, respectively, p=NS) and without CAD (49% and 51% respectively, p=NS). In both groups of patients with or without CAD, the extent and the severity of ischemia was not related to symptoms status, considering that SDS were not different between patients with and without symptoms.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
