BACKGROUND: Stress electrocardiogram(ECG)-gated single photon emission computed tomography (SPECT) imaging is highly effective in risk stratification of diabetic patients for adverse cardiac events. While patients with diabetes are predisposed to a more aggressive progression of vascular disease, the impact of its duration and type of therapy on risk stratification are unknown. METHODS: From the Hartford Hospital Nuclear Cardiology clinical database, 886 diabetic patients who underwent exercise or pharmacologic stress ECG-gated SPECT were identified, with complete follow-up regarding the occurrence of adverse cardiac events and information regarding the duration of diabetes and the type of therapy (insulin vs oral medication only) at the time of testing. Images were interpreted using the American College of Cardiology/ASNC standard 17-segment scoring model. RESULTS: Of the 886 diabetic patients, 98 (11%) suffered cardiac death or non-fatal myocardial infarction during follow-up (2.5 ± 1.6 years). A receiver operator characteristics curve demonstrated that diabetes ≥10 years in duration provided the maximal sum of sensitivity and specificity for the prediction of adverse cardiac outcomes. Multivariate analysis identified the following as independent predictors of adverse outcome: Post-stress ejection fraction (EF) <40% (P = .001), age (P = .004), insulin therapy (P = .031), diabetes duration >10 years (P = .038), summed stress score (SSS) >8 (P = .046). For patients with an SSS >8, diabetes duration and type of therapy significantly enhanced risk stratification. Similar findings emerged for patients with a post-stress EF <40%. CONCLUSION: For diabetic patients undergoing stress ECG-gated SPECT myocardial perfusion imaging, disease duration and type of therapy provide independent and incremental prognostic information. Integration of these variables with this cardiovascular imaging technology significantly enhances cardiac risk stratification.
BACKGROUND: Stress electrocardiogram(ECG)-gated single photon emission computed tomography (SPECT) imaging is highly effective in risk stratification of diabeticpatients for adverse cardiac events. While patients with diabetes are predisposed to a more aggressive progression of vascular disease, the impact of its duration and type of therapy on risk stratification are unknown. METHODS: From the Hartford Hospital Nuclear Cardiology clinical database, 886 diabeticpatients who underwent exercise or pharmacologic stress ECG-gated SPECT were identified, with complete follow-up regarding the occurrence of adverse cardiac events and information regarding the duration of diabetes and the type of therapy (insulin vs oral medication only) at the time of testing. Images were interpreted using the American College of Cardiology/ASNC standard 17-segment scoring model. RESULTS: Of the 886 diabeticpatients, 98 (11%) suffered cardiac death or non-fatal myocardial infarction during follow-up (2.5 ± 1.6 years). A receiver operator characteristics curve demonstrated that diabetes ≥10 years in duration provided the maximal sum of sensitivity and specificity for the prediction of adverse cardiac outcomes. Multivariate analysis identified the following as independent predictors of adverse outcome: Post-stress ejection fraction (EF) <40% (P = .001), age (P = .004), insulin therapy (P = .031), diabetes duration >10 years (P = .038), summed stress score (SSS) >8 (P = .046). For patients with an SSS >8, diabetes duration and type of therapy significantly enhanced risk stratification. Similar findings emerged for patients with a post-stress EF <40%. CONCLUSION: For diabeticpatients undergoing stress ECG-gated SPECT myocardial perfusion imaging, disease duration and type of therapy provide independent and incremental prognostic information. Integration of these variables with this cardiovascular imaging technology significantly enhances cardiac risk stratification.
Authors: Manuel D Cerqueira; Neil J Weissman; Vasken Dilsizian; Alice K Jacobs; Sanjiv Kaul; Warren K Laskey; Dudley J Pennell; John A Rumberger; Thomas Ryan; Mario S Verani Journal: Circulation Date: 2002-01-29 Impact factor: 29.690
Authors: R J Gibbons; G J Balady; J W Beasley; J T Bricker; W F Duvernoy; V F Froelicher; D B Mark; T H Marwick; B D McCallister; P D Thompson; W L Winters; F G Yanowitz; J L Ritchie; R J Gibbons; M D Cheitlin; K A Eagle; T J Gardner; A Garson; R P Lewis; R A O'Rourke; T J Ryan Journal: J Am Coll Cardiol Date: 1997-07 Impact factor: 24.094
Authors: X Kang; D S Berman; H C Lewin; I Cohen; J D Friedman; G Germano; R Hachamovitch; L J Shaw Journal: Am Heart J Date: 1999-12 Impact factor: 4.749
Authors: G F Lemp; R Vander Zwaag; J P Hughes; V Maddock; F Kroetz; K B Ramanathan; D M Mirvis; J M Sullivan Journal: Am J Cardiol Date: 1987-11-01 Impact factor: 2.778
Authors: R G Nelson; M L Sievers; W C Knowler; B A Swinburn; D J Pettitt; M F Saad; I M Liebow; B V Howard; P H Bennett Journal: Circulation Date: 1990-03 Impact factor: 29.690
Authors: Tanner M Fullmer; Shaobo Pei; Yi Zhu; Crystal Sloan; Robert Manzanares; Brandon Henrie; Karla M Pires; James E Cox; E Dale Abel; Sihem Boudina Journal: J Mol Cell Cardiol Date: 2013-08-30 Impact factor: 5.000
Authors: Jamieson M Bourque; Chetan A Patel; Mohamed M Ali; Margarita Perez; Denny D Watson; George A Beller Journal: Circ Cardiovasc Imaging Date: 2013-04-01 Impact factor: 7.792
Authors: Donna Chelle V Morales; Sanjeev P Bhavnani; Alan W Ahlberg; Raja C Pullatt; Deborah M Katten; Donna M Polk; Gary V Heller Journal: J Nucl Cardiol Date: 2017-12-06 Impact factor: 5.952
Authors: Maria João Vidigal Ferreira; Maria João Cunha; Anabela Albuquerque; Ana Paula Moreira; Domingos Ramos; Gracinda Costa; João Lima; Mariano Pego Journal: Int J Cardiovasc Imaging Date: 2013-06-04 Impact factor: 2.357