Document Detail


Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy.
MedLine Citation:
PMID:  16497686     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To determine the prevalence and clinical predictors of subclinical atherosclerosis and myocardial ischaemia in uncomplicated type 2 diabetes and assess their relationship to short-term outcome. METHODS AND RESULTS: Established risk factors and coronary artery calcium (CAC) scores were prospectively measured in 510 asymptomatic type 2 diabetic subjects (mean age 53+/-8 years, 61% males) without prior cardiovascular disease. Myocardial perfusion scintigraphy (MPS) was performed in all subjects with CAC > 100 Agatston units (AU) (n=127), and a random sample of the remaining patients with CAC < or = 100 AU (n=53). Significant CAC (> 10 AU) was found in 46.3%. Twenty events occurred (two coronary deaths, nine non-fatal myocardial infarctions, three acute coronary syndromes, three non-haemorrhagic strokes, and three late revascularisations) during a median follow-up of 2.2 years (25th-75th percentile = 1.9-2.5 years). The age, systolic blood pressure, the duration of diabetes, United Kingdom Prospective Diabetes Study risk score, CAC score, and extent of myocardial perfusion abnormality were significant predictors of time to cardiovascular events in a univariable Cox proportional hazard model. No cardiac events or perfusion abnormalities occurred in subjects with CAC < or = 10 AU up until 2 years of follow-up. CAC and MPS findings were synergistic for the prediction of short-term cardiovascular events. CONCLUSION: Subclinical atherosclerosis, measured by CAC imaging, is superior to the established cardiovascular risk factors for predicting silent myocardial ischaemia and short-term outcome. Further studies evaluating the impact of CAC imaging on clinical outcomes and its cost effectiveness are warranted.
Authors:
Dhakshinamurthy Vijay Anand; Eric Lim; David Hopkins; Roger Corder; Leslee J Shaw; Patrick Sharp; David Lipkin; Avijit Lahiri
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-02-23
Journal Detail:
Title:  European heart journal     Volume:  27     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-03-03     Completed Date:  2006-05-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  713-21     Citation Subset:  IM    
Affiliation:
Cardiac Imaging and Research Centre, Wellington Hospital (South), Wellington Place, St John's Wood, London NW8 9LE, UK. vdanand@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Calcinosis / radionuclide imaging*
Coronary Vessels / radionuclide imaging*
Diabetes Mellitus, Type 2 / complications*
Diabetic Angiopathies / radionuclide imaging*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Ischemia / radionuclide imaging*
Prognosis
Prospective Studies
Risk Factors
Comments/Corrections
Comment In:
Eur Heart J. 2006 Mar;27(6):631-2   [PMID:  16497691 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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