Detection of myocardial microvascular disease using contrast echocardiography during adenosine stress in type 2 diabetes mellitus

Prospective comparison with single-photon emission computed tomography

Sahar S. Abdelmoneim, Ananda Basu, Mathieu Bernier, Abhijeet Dhoble, Samir S. Abdel-Kader, Patricia Pellikka, Sharon L. Mulvagh

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purrpose: To evaluate myocardial microvascular disease in patients with type 2 diabetes mellitus (DM) using myocardial contrast echocardiography (MCE) and to report on its diagnostic accuracy using single photon emission tomography (SPECT) as reference test.Methods: We prospectively enrolled 79 patients (25 DM; 66±11 years) who underwent simultaneous SPECT and MCE with contrast agent during adenosine stress. MCE and SPECT were visually analyzed using 17 segments. Quantitative MCE parameters were derived from replenishment curves. Microbubble velocity (β min-1), absolute myocardial blood flow (MBF ml/min/g), and reserve values were calculated. Diagnostic accuracy and area under curve (AUC) was reported.Results: Patients with DM had higher BMI vs non DM (33±7 vs 28±5kg/m2 P=0.007), with more prior myocardial infarction (40 vs 15% P=.01). Visual MCE was abnormal in 40 (51%) patients (60% in DM vs 46% in non DM P=0.04). SPECT was abnormal in 38 (48%) patients [60% in DM vs 42% non DM, P=0.01]. Reserve parameters were lower in DM vs. non DM patients: (β 1.77±1.12 vs 2.20±1.4, P<0.001 and MBF 2.86± 2.62 vs. 3.67±2.84, P<0.001). DM patients without CAD on SPECT had significantly lower β, and MBF reserve compared to non DM patients without CAD. Compared to SPECT, β reserve cutoff 1.6 had AUC 0.817, sensitivity 81%, and specificity 66% while MBF reserve cutoff 1.9 had AUC 0.760, sensitivity 79%, and specificity 63% in DM patients.Conclusion: Diabetes is associated with myocardial microvascular abnormalities as evidenced by abnormal myocardial perfusion on visual and quantitative MCE.

Original languageEnglish (US)
Pages (from-to)254-261
Number of pages8
JournalDiabetes and Vascular Disease Research
Volume8
Issue number4
DOIs
StatePublished - Oct 2011

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Single-Photon Emission-Computed Tomography
Cardiomyopathies
Adenosine
Type 2 Diabetes Mellitus
Echocardiography
Diabetes Mellitus
Area Under Curve
Sensitivity and Specificity
Microbubbles
Photons
Contrast Media
Perfusion
Myocardial Infarction
Tomography

Keywords

  • Contrast echocardiography
  • coronary flow reserve
  • diabetes mellitus
  • microvascular diseases

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Detection of myocardial microvascular disease using contrast echocardiography during adenosine stress in type 2 diabetes mellitus : Prospective comparison with single-photon emission computed tomography. / Abdelmoneim, Sahar S.; Basu, Ananda; Bernier, Mathieu; Dhoble, Abhijeet; Abdel-Kader, Samir S.; Pellikka, Patricia; Mulvagh, Sharon L.

In: Diabetes and Vascular Disease Research, Vol. 8, No. 4, 10.2011, p. 254-261.

Research output: Contribution to journalArticle

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abstract = "Purrpose: To evaluate myocardial microvascular disease in patients with type 2 diabetes mellitus (DM) using myocardial contrast echocardiography (MCE) and to report on its diagnostic accuracy using single photon emission tomography (SPECT) as reference test.Methods: We prospectively enrolled 79 patients (25 DM; 66±11 years) who underwent simultaneous SPECT and MCE with contrast agent during adenosine stress. MCE and SPECT were visually analyzed using 17 segments. Quantitative MCE parameters were derived from replenishment curves. Microbubble velocity (β min-1), absolute myocardial blood flow (MBF ml/min/g), and reserve values were calculated. Diagnostic accuracy and area under curve (AUC) was reported.Results: Patients with DM had higher BMI vs non DM (33±7 vs 28±5kg/m2 P=0.007), with more prior myocardial infarction (40 vs 15{\%} P=.01). Visual MCE was abnormal in 40 (51{\%}) patients (60{\%} in DM vs 46{\%} in non DM P=0.04). SPECT was abnormal in 38 (48{\%}) patients [60{\%} in DM vs 42{\%} non DM, P=0.01]. Reserve parameters were lower in DM vs. non DM patients: (β 1.77±1.12 vs 2.20±1.4, P<0.001 and MBF 2.86± 2.62 vs. 3.67±2.84, P<0.001). DM patients without CAD on SPECT had significantly lower β, and MBF reserve compared to non DM patients without CAD. Compared to SPECT, β reserve cutoff 1.6 had AUC 0.817, sensitivity 81{\%}, and specificity 66{\%} while MBF reserve cutoff 1.9 had AUC 0.760, sensitivity 79{\%}, and specificity 63{\%} in DM patients.Conclusion: Diabetes is associated with myocardial microvascular abnormalities as evidenced by abnormal myocardial perfusion on visual and quantitative MCE.",
keywords = "Contrast echocardiography, coronary flow reserve, diabetes mellitus, microvascular diseases",
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T1 - Detection of myocardial microvascular disease using contrast echocardiography during adenosine stress in type 2 diabetes mellitus

T2 - Prospective comparison with single-photon emission computed tomography

AU - Abdelmoneim, Sahar S.

AU - Basu, Ananda

AU - Bernier, Mathieu

AU - Dhoble, Abhijeet

AU - Abdel-Kader, Samir S.

AU - Pellikka, Patricia

AU - Mulvagh, Sharon L.

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AB - Purrpose: To evaluate myocardial microvascular disease in patients with type 2 diabetes mellitus (DM) using myocardial contrast echocardiography (MCE) and to report on its diagnostic accuracy using single photon emission tomography (SPECT) as reference test.Methods: We prospectively enrolled 79 patients (25 DM; 66±11 years) who underwent simultaneous SPECT and MCE with contrast agent during adenosine stress. MCE and SPECT were visually analyzed using 17 segments. Quantitative MCE parameters were derived from replenishment curves. Microbubble velocity (β min-1), absolute myocardial blood flow (MBF ml/min/g), and reserve values were calculated. Diagnostic accuracy and area under curve (AUC) was reported.Results: Patients with DM had higher BMI vs non DM (33±7 vs 28±5kg/m2 P=0.007), with more prior myocardial infarction (40 vs 15% P=.01). Visual MCE was abnormal in 40 (51%) patients (60% in DM vs 46% in non DM P=0.04). SPECT was abnormal in 38 (48%) patients [60% in DM vs 42% non DM, P=0.01]. Reserve parameters were lower in DM vs. non DM patients: (β 1.77±1.12 vs 2.20±1.4, P<0.001 and MBF 2.86± 2.62 vs. 3.67±2.84, P<0.001). DM patients without CAD on SPECT had significantly lower β, and MBF reserve compared to non DM patients without CAD. Compared to SPECT, β reserve cutoff 1.6 had AUC 0.817, sensitivity 81%, and specificity 66% while MBF reserve cutoff 1.9 had AUC 0.760, sensitivity 79%, and specificity 63% in DM patients.Conclusion: Diabetes is associated with myocardial microvascular abnormalities as evidenced by abnormal myocardial perfusion on visual and quantitative MCE.

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KW - coronary flow reserve

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