Donghee Han1, Alan Rozanski2, Heidi Gransar1, Tali Sharir3,4, Andrew J Einstein5, Mathews B Fish6, Terrence D Ruddy7, Philipp A Kaufmann8, Albert J Sinusas9, Edward J Miller9, Timothy M Bateman10, Sharmila Dorbala11, Marcelo Di Carli11, Joanna X Liang1, Lien-Hsin Hu1,12, Guido Germano1, Damini Dey1, Daniel S Berman1, Piotr J Slomka13. 1. Division of Nuclear Medicine, Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA. 2. Division of Cardiology, Mount Sinai St. Luke's Hospital, New York, NY. 3. Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel. 4. Ben Gurion University of the Negev, Beersheba, Israel. 5. Division of Cardiology, Departments of Medicine and Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY. 6. Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR. 7. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 8. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland. 9. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT. 10. Cardiovascular Imaging Technologies LLC, Kansas City, MO. 11. Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, MA. 12. Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 13. Division of Nuclear Medicine, Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA piotr.slomka@cshs.org.
Abstract
OBJECTIVE: Prevalence and prognostic impact of cardiovascular disease differ between patients with or without diabetes. We aimed to explore differences in the prevalence and prognosis of myocardial ischemia by automated quantification of total perfusion deficit (TPD) among patients with and without diabetes. RESEARCH DESIGN AND METHODS: Of 20,418 individuals who underwent single-photon emission computed tomography myocardial perfusion imaging, 2,951 patients with diabetes were matched to 2,951 patients without diabetes based on risk factors using propensity score. TPD was categorized as TPD = 0%, 0% < TPD < 1%, 1% ≤ TPD < 5%, 5% ≤ TPD ≤ 10%, and TPD >10%. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, unstable angina, or late revascularization. RESULTS: MACE risk was increased in patients with diabetes compared with patients without diabetes at each level of TPD above 0 (P < 0.001 for interaction). In patients with TPD >10%, patients with diabetes had greater than twice the MACE risk compared with patients without diabetes (annualized MACE rate 9.4 [95% CI 6.7-11.6] and 3.9 [95% CI 2.8-5.6], respectively, P < 0.001). Patients with diabetes with even very minimal TPD (0% < TPD < 1%) experienced a higher risk for MACE than those with 0% TPD (hazard ratio 2.05 [95% CI 1.21-3.47], P = 0.007). Patients with diabetes with a TPD of 0.5% had a similar MACE risk as patients without diabetes with a TPD of 8%. CONCLUSIONS: For every level of TPD >0%, even a very minimal deficit of 0% < TPD < 1%, the MACE risk was higher in the patients with diabetes compared with patients without diabetes. Patients with diabetes with minimal ischemia had comparable MACE risk as patients without diabetes with significant ischemia.
OBJECTIVE: Prevalence and prognostic impact of cardiovascular disease differ between patients with or without diabetes. We aimed to explore differences in the prevalence and prognosis of myocardial ischemia by automated quantification of total perfusion deficit (TPD) among patients with and without diabetes. RESEARCH DESIGN AND METHODS: Of 20,418 individuals who underwent single-photon emission computed tomography myocardial perfusion imaging, 2,951 patients with diabetes were matched to 2,951 patients without diabetes based on risk factors using propensity score. TPD was categorized as TPD = 0%, 0% < TPD < 1%, 1% ≤ TPD < 5%, 5% ≤ TPD ≤ 10%, and TPD >10%. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, unstable angina, or late revascularization. RESULTS: MACE risk was increased in patients with diabetes compared with patients without diabetes at each level of TPD above 0 (P < 0.001 for interaction). In patients with TPD >10%, patients with diabetes had greater than twice the MACE risk compared with patients without diabetes (annualized MACE rate 9.4 [95% CI 6.7-11.6] and 3.9 [95% CI 2.8-5.6], respectively, P < 0.001). Patients with diabetes with even very minimal TPD (0% < TPD < 1%) experienced a higher risk for MACE than those with 0% TPD (hazard ratio 2.05 [95% CI 1.21-3.47], P = 0.007). Patients with diabetes with a TPD of 0.5% had a similar MACE risk as patients without diabetes with a TPD of 8%. CONCLUSIONS: For every level of TPD >0%, even a very minimal deficit of 0% < TPD < 1%, the MACE risk was higher in the patients with diabetes compared with patients without diabetes. Patients with diabetes with minimal ischemia had comparable MACE risk as patients without diabetes with significant ischemia.
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