Identifying high-risk asymptomatic diabetic patients who are candidates for screening stress single-photon emission computed tomography imaging

Navin Rajagopalan, Todd D. Miller, David O. Hodge, Robert L. Frye, Raymond J. Gibbons

Research output: Contribution to journalArticlepeer-review

182 Scopus citations

Abstract

The purpose of this study was to identify which asymptomatic diabetic patients are candidates for screening single-photon emission computed tomography (SPECT) imaging and to examine angiographic findings and mortality in patients according to SPECT imaging categories. Previously we reported a high percentage of abnormal and high-risk SPECT imaging scans in asymptomatic diabetic patients. We examined the associations between several clinical and laboratory variables and a high-risk stress SPECT imaging scan in 1,427 asymptomatic diabetic patients without known coronary artery disease (CAD). Results of coronary angiography and long-term outcome were also analyzed. An abnormal stress SPECT imaging scan was present in 826 patients (58%) and a high-risk scan in 261 patients (18%). Multivariate analysis demonstrated that seven variables were independently associated with a high-risk scan (model chi-square = 107, p < 0.0001). The two most important variables were electrocardiogram (ECG) Q waves (adjusted chi-square = 38.3, p < 0.001) and peripheral arterial disease (PAD) (adjusted chi-square = 13.9, p < 0.001). Coronary angiography was performed in 127 (49%) high-risk SPECT imaging patients, 61% of whom had angiographic high-risk CAD. Annual mortality rates for patient subsets categorized by SPECT imaging scans were high-risk 5.9%, intermediate-risk 5.0%, and low-risk 3.6% (p < 0.001 for differences between groups). High-risk findings on stress SPECT imaging were present in 18% of asymptomatic diabetic patients without known CAD. Patients with high-risk scans had a high prevalence of severe CAD and a high annual mortality rate. ECG Q waves and/or evidence of PAD identified the most suitable candidates for screening.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalJournal of the American College of Cardiology
Volume45
Issue number1
DOIs
StatePublished - Jan 4 2005

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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