Normal Heart Imaging Linked to Lower Coronary Artery Disease Events in Diabetes

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Normal Heart Imaging Linked to Lower Coronary Artery Disease Events in Diabetes
Normal Heart Imaging Linked to Lower Coronary Artery Disease Events in Diabetes

(HealthDay News) — High-risk asymptomatic patients with diabetes and normal myocardial perfusion single-photon emission computed tomography (MPS) have a low rate of first manifestations of coronary artery disease (CAD); however, patients with diabetes and abnormal MPS have a seven-fold higher rate of progression to overt or silent CAD despite therapy. 

These findings were published in JACC: Cardiovascular Imaging.

Michael J. Zellweger, MD, from the University of Basel in Switzerland, and colleagues conducted clinical evaluations and MPS at baseline and after 2 years in 400 asymptomatic patients with diabetes without history or symptoms of CAD. Those individuals with abnormal MPS received medical or combined invasive and medical management.

The researchers found that abnormal MPS was identified in 87 of 400 patients (22%). Major adverse cardiac events (MACE) occurred in 2.9% of patients with normal MPS and ischemia or new scar occurred in 3.2%. 

A higher incidence of MACE occurred in patients with abnormal MPS (9.8%; hazard ratio=3.44; P=.011), as well as more ischemia or new scar (34.2%; odds ratio [OR]=15.91; P<.001). 

Despite therapy in patients with abnormal MPS, there was "overt or silent CAD progression" in 35.6% vs. 4.6% for normal MPS (OR=11.53; P<.001). 

For patients randomly assigned to medical vs. invasive-medical strategies with abnormal MPS, there were more ischemic or new scar findings (54.3% vs. 15.8%; P<.001) but similar event rates (P=.215).

"Randomized patients' outcomes suggest that a combined invasive and medical strategy for silent CAD may reduce scintigraphic but not symptomatic CAD progression versus medical therapy alone," the researchers wrote.

Roche, Pfizer, Takeda, and Heider & Co. partially funded the study.

Reference

  1. Zellweger MJ et al. J Am Coll Cardiol Img. 2014;7(10):1001-1010.
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