TY - JOUR
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 A.
AU - Mulvagh, Sharon L.
N1 - Funding Information:
This study was supported by research funding from Astellas Pharma Inc. Adenosine (Adenoscan) was provided by Astellas Pharma Inc. (Deerfield, IL). Contrast agent (Definity) was provided as part of research grant by Lantheus Medical Imaging (North Billerica, MA).
Funding Information:
Dr Sharon L. Mulvagh has received research grants from Lantheus Medical Imaging and Astellas Pharma US, Inc. All other authors have nothing to declare.
PY - 2011/10
Y1 - 2011/10
N2 - 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.
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.
KW - Contrast echocardiography
KW - coronary flow reserve
KW - diabetes mellitus
KW - microvascular diseases
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U2 - 10.1177/1479164111419973
DO - 10.1177/1479164111419973
M3 - Article
C2 - 21933841
AN - SCOPUS:80053074584
SN - 1479-1641
VL - 8
SP - 254
EP - 261
JO - Diabetes and Vascular Disease Research
JF - Diabetes and Vascular Disease Research
IS - 4
ER -