Page 106 - Petelin, Ana, Nejc Šarabon, Boštjan Žvanut, eds. 2017. Zdravje delovno aktivne populacije ▪︎ Health of the Working-Age Population. Proceedings. Koper: Založba Univerze na Primorskem/University of Primorska Press
P. 106
avje delovno aktivne populacije | health of the working-age population 104 Myocardial ischemia is often asymptomatic in patients with type 2 di-
abetes mellitus (T2DM) and coronary artery disease (CAD) is fre-
quently in an advanced stage when it becomes clinically manifested.
Silent myocardial ischemia (SMI) is defined as objective evidence of myocardi-
al ischemia in the absence of typical chest discomfort or other anginal equiv-
alents. It is a common, under-recognized marker of a significant underlying
CAD associated with future cardiovascular events and poor prognosis. SMI is
an important public health issue, and its early detection may prevent many ep-
isodes of sudden cardiac death annually (Cosson et al., 2005; Le Feuvre et al.,
2011; Vasiliadis et al., 2014). Diabetic patients have a higher prevalence of SMI
and recognised myocardial infarction than patients without diabetes (Mac-
Donald et al., 2014). There are some data about the prevalence of SMI in T2DM
patients in elderly at high risk for cardiovascular disease (Inoguchi et al., 2000;
Faglia et al., 2002; Lima et al., 2004; Mohagheghie et al., 2011; Rawshani et al.,
2017). However, data about the prevalence of SMI in working-age subgroup of
the diabetic population remain limited.
Stress single-photon emission computed tomography (SPECT) is a vali-
dated imaging tool providing information on the physiological significance of
flow-limitation and is also a cost-effective for risk assessment of the major ad-
verse cardiac events in the general and diabetic populations. SPECT could ac-
curately assess both myocardial perfusion and ventricular function in diabetic
patients, providing important information for their management and is help-
ful in these situations (De Keyzer et al., 2011). Moreover, left ventricular (LV)
function analysis in SPECT can enhances its prognostic and diagnostic ability,
particularly in the prediction of SMI (Sharir et al., 1999). We sought to evaluate
the prevalence of SMI detected by SPECT myocardial perfusion imaging (MPI)
in association with some less recognised diagnostic predictors of it in T2DM
asymptomatic patients of working-age.
Methods
We retrospectively analysed medical records of 192 (110 male pts; 57.3%) chron-
ologically consecutive asymptomatic working-age (≤60 years) patients with
T2DM, who had undergone MPI subsequently followed by coronary angiog-
raphy in case perfusion abnormalities were found. MPI was performed from
2010 to 2014 at a single outpatient care centre with nuclear medicine unit, ac-
cording to the EANM procedural guidelines for stress-rest ECG gated SPECT
one-day protocol using 99mTc-tetrofosmin (Verberne et al., 2015). Perfusion
images were judged blindly by two specialists independently using the 17-seg-
ment ASNC model, and SMI was diagnosed consensually as myocardial per-
fusion abnormalities without associated symptoms. Stress (cycle ergometry)
and rest myocardial perfusion abnormalities were described as reversible (is-
chemia), fixed (scar), or mixed (scar and ischemia). The summed stress score
(SSS) and summed rest score (SRS) were obtained, with the summed difference
score (SDS) being the difference between the two. A mild ischemic defect was
abetes mellitus (T2DM) and coronary artery disease (CAD) is fre-
quently in an advanced stage when it becomes clinically manifested.
Silent myocardial ischemia (SMI) is defined as objective evidence of myocardi-
al ischemia in the absence of typical chest discomfort or other anginal equiv-
alents. It is a common, under-recognized marker of a significant underlying
CAD associated with future cardiovascular events and poor prognosis. SMI is
an important public health issue, and its early detection may prevent many ep-
isodes of sudden cardiac death annually (Cosson et al., 2005; Le Feuvre et al.,
2011; Vasiliadis et al., 2014). Diabetic patients have a higher prevalence of SMI
and recognised myocardial infarction than patients without diabetes (Mac-
Donald et al., 2014). There are some data about the prevalence of SMI in T2DM
patients in elderly at high risk for cardiovascular disease (Inoguchi et al., 2000;
Faglia et al., 2002; Lima et al., 2004; Mohagheghie et al., 2011; Rawshani et al.,
2017). However, data about the prevalence of SMI in working-age subgroup of
the diabetic population remain limited.
Stress single-photon emission computed tomography (SPECT) is a vali-
dated imaging tool providing information on the physiological significance of
flow-limitation and is also a cost-effective for risk assessment of the major ad-
verse cardiac events in the general and diabetic populations. SPECT could ac-
curately assess both myocardial perfusion and ventricular function in diabetic
patients, providing important information for their management and is help-
ful in these situations (De Keyzer et al., 2011). Moreover, left ventricular (LV)
function analysis in SPECT can enhances its prognostic and diagnostic ability,
particularly in the prediction of SMI (Sharir et al., 1999). We sought to evaluate
the prevalence of SMI detected by SPECT myocardial perfusion imaging (MPI)
in association with some less recognised diagnostic predictors of it in T2DM
asymptomatic patients of working-age.
Methods
We retrospectively analysed medical records of 192 (110 male pts; 57.3%) chron-
ologically consecutive asymptomatic working-age (≤60 years) patients with
T2DM, who had undergone MPI subsequently followed by coronary angiog-
raphy in case perfusion abnormalities were found. MPI was performed from
2010 to 2014 at a single outpatient care centre with nuclear medicine unit, ac-
cording to the EANM procedural guidelines for stress-rest ECG gated SPECT
one-day protocol using 99mTc-tetrofosmin (Verberne et al., 2015). Perfusion
images were judged blindly by two specialists independently using the 17-seg-
ment ASNC model, and SMI was diagnosed consensually as myocardial per-
fusion abnormalities without associated symptoms. Stress (cycle ergometry)
and rest myocardial perfusion abnormalities were described as reversible (is-
chemia), fixed (scar), or mixed (scar and ischemia). The summed stress score
(SSS) and summed rest score (SRS) were obtained, with the summed difference
score (SDS) being the difference between the two. A mild ischemic defect was
