Michiel A de Graaf1, Cornelis J Roos1, Josanne M Mansveld2, Aan V Kharagjitsingh3, Petra Dibbets-Schneider4, Lucia J Kroft5, J Wouter Jukema1, Edward P Ficaro6, Jeroen J Bax2, Arthur J Scholte7. 1. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. 2. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. 3. Department of Internal Medicine, Westeinde Hospital, The Hague, The Netherlands. 4. Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands. 5. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 6. Department of Radiology, Division of Nuclear Medicine, The University of Michigan Medical Center, Ann Arbor, MI, USA. 7. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands a.j.h.a.scholte@lumc.nl.
Abstract
AIMS: 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. METHODS AND 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. CONCLUSION: 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. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: 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. METHODS AND 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. CONCLUSION: 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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: David A Halon; Mali Azencot; Ronen Rubinshtein; Barak Zafrir; Moshe Y Flugelman; Basil S Lewis Journal: J Am Heart Assoc Date: 2016-06-13 Impact factor: 5.501