Myocardial Perfusion Scintigraphy in Diabetes: Current Status and Limitations
Patients with diabetes have greater cardiovascular disease morbidity and mortality than non-diabetic patients. Since the beginning of clinical nuclear cardiology over two decades ago, myocardial perfusion scintigraphy has become a mature technique for eva
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Myocardial Perfusion Scintigraphy in Diabetes: Current Status and Limitations
27
John O. Prior
Contents
27.1 27.1.1 27.1.2 27.1.3 27.2 27.2.1 27.2.2 27.2.3 27.2.4 27.2.5 27.3 27.3.1 27.3.2 27.3.3 27.3.4 27.3.5 27.4 27.4.1 27.4.2 27.4.3 27.4.4 27.4.5 27.5 27.5.1 27.5.2 27.5.3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 305 CAD and Diabetes . . . . . . . . . . . . . . . . . . . . . 305 Asymptomatic CAD in Diabetes . . . . . . . . . 306 Early Diagnosis of CAD in Patients with Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . 307 Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307 Exercise Tolerance Testing . . . . . . . . . . . . . . 307 Stress Myocardial Perfusion Scintigraphy 307 Stress MPS with ECG-gated SPECT . . . . . . 307 Stress echocardiography . . . . . . . . . . . . . . . . 309 Coronary Angiography . . . . . . . . . . . . . . . . . 309 Clinical Applications of Stress MPS . . . . . . 311 Diagnosis and Assessment of CAD in DM Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Risk Stratification of CAD in DM Patients . 311 MPS in Symptomatic CAD Patients with Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . 312 MPS in Asymptomatic CAD Patients with Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . 313 Asymptomatic Patients with Diabetes: Who to Screen? . . . . . . . . . . . . . . . . . . . . . . . 314 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 Reduced Cardiac Survival in Women with Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . 315 Frequency of Stress MPS in Patients with Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . 315 Special Considerations for Type 1 Diabetes 316 Emerging Role of Coronary Calcium . . . . . 316 Management of CAD Patients with Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . 316 Future Trends . . . . . . . . . . . . . . . . . . . . . . . . . 317 Screening Asymptomatic Patients with DM for CAD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 SPECT-CT and Other Noninvasive Cardiac Imaging Modalities . . . . . . . . . . . . . . . . . . . . 317 Future Challenges for MPS in Diabetic and Prediabetic Patients . . . . . . . . . . . . . . . . 318 References . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
27.1
Introduction
Patients with diabetes have greater cardiovascular disease morbidity and mortality than non-diabetic patients. Since the beginning of clinical nuclear cardiology over two decades ago, myocardial perfusion scintigraphy has become a mature technique for evaluating coronary artery disease and several studies have specifically shown prognostic power in patients with diabetes. Silent ischemia is frequent and associated with a similar or poorer prognosis as non-silent disease. Current opinion is to recommend stress myocardial perfusion scintigraphy in symptomatic or high-risk asymptomatic patients, and the effectiveness of this
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