Lihua Zhang1, Hong Li2, Simin Zhang3, Lindsay M Jaacks4, Yufeng Li3, Linong Ji5. 1. Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China; Department of Geriatrics, The First Affiliated Hospital, Kunming Medical University, Kunming, China. 2. Department of Endocrinology and Metabolism, The First Affiliated Hospital, Kunming Medical University, Kunming, China. 3. Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China. 4. Department of Nutrition, The University of North Carolina, Chapel Hill, NC, USA. 5. Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China. Electronic address: jiln@bjmu.edu.cn.
Abstract
OBJECTIVE: To assess the value of detecting silent myocardial ischemia (SMI) by single photon emission computed tomography (SPECT) in predicting risk of cardiac events among patients with type 2 diabetes mellitus (T2DM) who do not have overt cardiac symptoms. MATERIALS AND METHODS: Electronic databases (PubMed, Cochrane Library, EMBASE, and others) and original article references were systematically searched through February 1, 2013. A fixed-effects model was applied to pooled data to estimate relative risks (RR) and 95% confidence intervals (CI). RESULTS: Ten prospective studies with follow-up ranging from 1 to 6 years were identified. Among the total of 1360 asymptomatic patients with T2DM screened by SPECT, the cumulative prevalence rate of SMI was 26.1%. Patients with SMI were at increased risk of experiencing endpoints relative to patients without SMI: RR (95% CI) for cardiac death, 4.60 (1.78-11.84); non-fatal cardiac events, 3.48 (2.30-5.28); total cardiac events, 3.48 (2.59-4.68); and all-cause mortality, 2.20 (1.14-4.25). The risk of cardiac death and non-fatal cardiac events increased with increasing severity of SPECT-detected abnormalities. CONCLUSIONS: SMI detected by SPECT is associated with increased risk of cardiac death, all-cause mortality, and non-fatal cardiac events in T2DM patients without overt cardiac symptoms. Advanced intervention procedures including intensive drug management should be implemented to reduce the risk of cardiac events for SMI-positive T2DM patients.
OBJECTIVE: To assess the value of detecting silent myocardial ischemia (SMI) by single photon emission computed tomography (SPECT) in predicting risk of cardiac events among patients with type 2 diabetes mellitus (T2DM) who do not have overt cardiac symptoms. MATERIALS AND METHODS: Electronic databases (PubMed, Cochrane Library, EMBASE, and others) and original article references were systematically searched through February 1, 2013. A fixed-effects model was applied to pooled data to estimate relative risks (RR) and 95% confidence intervals (CI). RESULTS: Ten prospective studies with follow-up ranging from 1 to 6 years were identified. Among the total of 1360 asymptomatic patients with T2DM screened by SPECT, the cumulative prevalence rate of SMI was 26.1%. Patients with SMI were at increased risk of experiencing endpoints relative to patients without SMI: RR (95% CI) for cardiac death, 4.60 (1.78-11.84); non-fatal cardiac events, 3.48 (2.30-5.28); total cardiac events, 3.48 (2.59-4.68); and all-cause mortality, 2.20 (1.14-4.25). The risk of cardiac death and non-fatal cardiac events increased with increasing severity of SPECT-detected abnormalities. CONCLUSIONS:SMI detected by SPECT is associated with increased risk of cardiac death, all-cause mortality, and non-fatal cardiac events in T2DM patients without overt cardiac symptoms. Advanced intervention procedures including intensive drug management should be implemented to reduce the risk of cardiac events for SMI-positive T2DM patients.
Authors: Zhu Xiao-Rong; Zhang Hui-Rong; Li Mei; Zhou Zhen; Liu Wei; Lu Jing; Yang Guang-Ran; Zhou Jian-Bo; Yang Jin-Kui Journal: Medicine (Baltimore) Date: 2019-05 Impact factor: 1.817
Authors: Pupalan Iyngkaran; William Chan; Danny Liew; Jalal Zamani; John D Horowitz; Michael Jelinek; David L Hare; James A Shaw Journal: World J Methodol Date: 2019-01-18