מתוך medicontext.co.il
By Anthony J. Brown, MD
NEW YORK (Reuters Health) – The presence and extent of abnormal findings on stress myocardial perfusion imaging (MPI)–already a well-established method of stratifying cardiac risk in the general population–can also be used to predict cardiac events in diabetic patients, according to a report published in the January 1/8th issue of Circulation.
Dr. Gary V. Heller, from Hartford Hospital in Connecticut, and colleagues assessed the predictive value of stress MPI in 4755 patients with symptoms of coronary artery disease. The study group included 929 diabetic patients. On average, the patients were followed for 2.5 years after undergoing stress MPI.
Diabetics had a significantly higher (p < 0.0001) cardiac event rate (8.6%) than nondiabetics (4.5%), the authors note. In both populations, stress MPI was found to be an independent predictor of myocardial infarction (MI) and cardiac death.
In diabetics, the presence of ischemic defects was significantly linked to cardiac events (p < 0.001). The highest MI rates were observed in diabetics with 3-vessel ischemia, the researchers state. Diabetics with multivessel fixed defects had the highest rate of cardiac death.
In a related editorial, Dr. Frans J. T. Wackers and Dr. Barry L. Zaret, from the Yale University School of Medicine in New Haven, Connecticut, comment on the detection of myocardial ischemia in diabetic patients.
"The current findings are important, but you have to remember that these patients were referred for cardiac work-up in the first place," Dr. Wackers told Reuters Health.
"We are currently doing a study of asymptomatic diabetic patients to determine the prevalence of perfusion abnormalities on stress MPI," Dr. Wackers noted. "We've found that about 20% to 25% of patients have completely silent coronary artery disease," he added.
Dr. Wackers believes that "the challenge now is deciding when to do stress MPI." The diabetic patient population is large, "so it would be optimal to identify a subset that is most likely to have abnormal stress MPI findings," he said. "At this point, our findings suggest that the presence of autonomic disfunction may be useful in determining which patients should be screened with stress MPI."
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