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Prognostic value of gated myocardial perfusion imaging for asymptomatic patients with type 2 diabetes: the J-ACCESS 2 investigation.

Yamasaki Y, Nakajima K, Kusuoka H, Izumi T, Kashiwagi A, Kawamori R, Shimamoto K, Yamada N, Nishimura T - Diabetes Care (2010)

Bottom Line: Patients with summed stress scores (SSS) of ≥9 had a significantly higher incidence (of either death or cardiovascular events) than those with SSS scores of <9 (23 vs. 12%; P=0.009).Multivariate Cox regression analysis showed that significant variables were SSS≥9, a low estimated glomerular filtration rate, and being a current smoker.Univariate Cox regression analysis showed that ticlopidine and insulin use are potent medical modulators of cardiovascular events.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Metabolism, Osaka University, Suita, Japan. yamasaki@medone.med.osaka-u.ac.jp

ABSTRACT

Objective: Individuals with type 2 diabetes are at high risk for cardiovascular events. We evaluated the prognostic value of gated myocardial perfusion single-photon computed tomography (SPECT) for asymptomatic diabetic patients in a Japanese population.

Research design and methods: Asymptomatic patients (n=485) aged≥50 years with either a maximal carotid artery intima-media thickness of ≥1.1 mm, or a urinary albumin ≥30 mg/g creatinine or who had at least two of the following, abdominal obesity, low HDL cholesterol, high triglyceride levels, and hypertension, were enrolled at 50 institutions. The patients were evaluated using gated SPECT with the stress-rest protocol and followed up for 3 years.

Results: During the follow-up period, 62 (13%) events occurred, including 5 cardiac deaths and 57 cardiovascular events. Patients with summed stress scores (SSS) of ≥9 had a significantly higher incidence (of either death or cardiovascular events) than those with SSS scores of <9 (23 vs. 12%; P=0.009). Multivariate Cox regression analysis showed that significant variables were SSS≥9, a low estimated glomerular filtration rate, and being a current smoker. Univariate Cox regression analysis showed that ticlopidine and insulin use are potent medical modulators of cardiovascular events.

Conclusions: The incidences of cardiovascular events and death were significantly high in a select population of type 2 diabetic patients with SPECT abnormalities. A targeted treatment strategy is required for asymptomatic but potentially high-risk patients with type 2 diabetes.

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Related in: MedlinePlus

Event-free survival in low (<9) and high (≥9) SSS groups.
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Figure 2: Event-free survival in low (<9) and high (≥9) SSS groups.

Mentions: Figure 2 shows Kaplan-Meier curves for event-free survival for cardiac events. At the end of follow-up, the event-free rates were 0.88 and 0.77 for the groups with low and high SSS, respectively (P = 0.009). The urinary excretion rate of albumin was higher in the high SSS group (P = 0.017). ECG revealed a higher incidence of segmental wall motion abnormalities (P = 0.013) and the myocardial perfusion defect scores of SRS and SDS were higher (both P < 0.0001) in the high SSS group. Both EDV and ESV were higher, whereas EF was lower in the high SSS group (all P < 0.0001; Table 1).


Prognostic value of gated myocardial perfusion imaging for asymptomatic patients with type 2 diabetes: the J-ACCESS 2 investigation.

Yamasaki Y, Nakajima K, Kusuoka H, Izumi T, Kashiwagi A, Kawamori R, Shimamoto K, Yamada N, Nishimura T - Diabetes Care (2010)

Event-free survival in low (<9) and high (≥9) SSS groups.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2963487&req=5

Figure 2: Event-free survival in low (<9) and high (≥9) SSS groups.
Mentions: Figure 2 shows Kaplan-Meier curves for event-free survival for cardiac events. At the end of follow-up, the event-free rates were 0.88 and 0.77 for the groups with low and high SSS, respectively (P = 0.009). The urinary excretion rate of albumin was higher in the high SSS group (P = 0.017). ECG revealed a higher incidence of segmental wall motion abnormalities (P = 0.013) and the myocardial perfusion defect scores of SRS and SDS were higher (both P < 0.0001) in the high SSS group. Both EDV and ESV were higher, whereas EF was lower in the high SSS group (all P < 0.0001; Table 1).

Bottom Line: Patients with summed stress scores (SSS) of ≥9 had a significantly higher incidence (of either death or cardiovascular events) than those with SSS scores of <9 (23 vs. 12%; P=0.009).Multivariate Cox regression analysis showed that significant variables were SSS≥9, a low estimated glomerular filtration rate, and being a current smoker.Univariate Cox regression analysis showed that ticlopidine and insulin use are potent medical modulators of cardiovascular events.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Metabolism, Osaka University, Suita, Japan. yamasaki@medone.med.osaka-u.ac.jp

ABSTRACT

Objective: Individuals with type 2 diabetes are at high risk for cardiovascular events. We evaluated the prognostic value of gated myocardial perfusion single-photon computed tomography (SPECT) for asymptomatic diabetic patients in a Japanese population.

Research design and methods: Asymptomatic patients (n=485) aged≥50 years with either a maximal carotid artery intima-media thickness of ≥1.1 mm, or a urinary albumin ≥30 mg/g creatinine or who had at least two of the following, abdominal obesity, low HDL cholesterol, high triglyceride levels, and hypertension, were enrolled at 50 institutions. The patients were evaluated using gated SPECT with the stress-rest protocol and followed up for 3 years.

Results: During the follow-up period, 62 (13%) events occurred, including 5 cardiac deaths and 57 cardiovascular events. Patients with summed stress scores (SSS) of ≥9 had a significantly higher incidence (of either death or cardiovascular events) than those with SSS scores of <9 (23 vs. 12%; P=0.009). Multivariate Cox regression analysis showed that significant variables were SSS≥9, a low estimated glomerular filtration rate, and being a current smoker. Univariate Cox regression analysis showed that ticlopidine and insulin use are potent medical modulators of cardiovascular events.

Conclusions: The incidences of cardiovascular events and death were significantly high in a select population of type 2 diabetic patients with SPECT abnormalities. A targeted treatment strategy is required for asymptomatic but potentially high-risk patients with type 2 diabetes.

Show MeSH
Related in: MedlinePlus