ArticleJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology2010
Duration and type of therapy for diabetes: impact on cardiac risk stratification with stress electrocardiographic-gated SPECT myocardial perfusion imaging.
Article in Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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12 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Prognostic value of normal stress myocardial perfusion imaging in diabetic patients: a meta-analysis.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2014Pooled it
- Gender differences in outcome in patients with diabetes mellitus.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2022Article
- Coronary risk equivalence of diabetes assessed by SPECT-MPI.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2019Article
- Use of imaging and clinical data to screen for cardiovascular disease in asymptomatic diabetics.Cardiovascular diabetology · 2016Article
- Predictive value of high-sensitivity troponin-I for future adverse cardiovascular outcome in stable patients with type 2 diabetes mellitus.Cardiovascular diabetology · 2014Article
- Insulin suppresses ischemic preconditioning-mediated cardioprotection through Akt-dependent mechanisms.Journal of molecular and cellular cardiology · 2013Article
- Prognosis of normal stress-only gated-SPECT myocardial perfusion imaging: a single center study.The international journal of cardiovascular imaging · 2013Article
- Prevalence and predictors of ischemia and outcomes in outpatients with diabetes mellitus referred for single-photon emission computed tomography myocardial perfusion imaging.Circulation. Cardiovascular imaging · 2013Article
- Prognosis in the era of comparative effectiveness research: where is nuclear cardiology now and where should it be?Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2012Review
- Association between plasma homocysteine and myocardial SPECT abnormalities in patients referred for suspected myocardial ischaemia.Cardiovascular journal of Africa · 2012Article
- Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: a comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2011Article
- Risk stratification in diabetes: not all patients or perfusion defects are the same.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2010Article
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Authors and funding
6 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundStress electrocardiogram(ECG)-gated single photon emission computed tomography (SPECT) imaging is highly effective in risk stratification of diabetic patients for adverse cardiac events. While patients with diabetes are predisposed to a more aggressive progression of vascular disease, the impact of its duration and type of therapy on risk stratification are unknown.
methodsFrom the Hartford Hospital Nuclear Cardiology clinical database, 886 diabetic patients who underwent exercise or pharmacologic stress ECG-gated SPECT were identified, with complete follow-up regarding the occurrence of adverse cardiac events and information regarding the duration of diabetes and the type of therapy (insulin vs oral medication only) at the time of testing. Images were interpreted using the American College of Cardiology/ASNC standard 17-segment scoring model.
resultsOf the 886 diabetic patients, 98 (11%) suffered cardiac death or non-fatal myocardial infarction during follow-up (2.5 ± 1.6 years). A receiver operator characteristics curve demonstrated that diabetes ≥10 years in duration provided the maximal sum of sensitivity and specificity for the prediction of adverse cardiac outcomes. Multivariate analysis identified the following as independent predictors of adverse outcome: Post-stress ejection fraction (EF) <40% (P = .001), age (P = .004), insulin therapy (P = .031), diabetes duration >10 years (P = .038), summed stress score (SSS) >8 (P = .046). For patients with an SSS >8, diabetes duration and type of therapy significantly enhanced risk stratification. Similar findings emerged for patients with a post-stress EF <40%.
conclusionFor diabetic patients undergoing stress ECG-gated SPECT myocardial perfusion imaging, disease duration and type of therapy provide independent and incremental prognostic information. Integration of these variables with this cardiovascular imaging technology significantly enhances cardiac risk stratification.
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