Assessment of Ischemia in Asymptomatic Type II Diabetics versus Asymptomatic patients with other Risk Factors of Coronary Artery Disease. Preliminary Data from GSPECT Tc99m sestaMIBI Myocardial Perfusion Imaging Study in Egyptian Patients.
Akram Abd Elbary,1; Mohamed Khaled,1Wael Sami1; Mohga Said2, Hala Zakaria2, Lamiaa Hamed3, Shaban Mohamed4; and Alia Abd El-Fattah4
1 Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
2 Lab Department Critical Care Medicine Department, Faculty of Medicine Cairo University, Cairo, Egypt
3.Statistics Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
4. Medical physicians Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.email@example.com
Abstract: Background and Aim: Diabetes mellitus is a recognized risk factor for coronary artery disease (CAD). However ischemia in diabetics may express their ischemia as atypical symptoms. We aimed at comparing incidence and extent of diabetic vs. non diabetic with other risk factors for CAD. Patients: The study included 46 pts with 1 or 2 risk factors for CAD mean age 55+6 years, 18 males. Methods: Patients were subjected to laboratory assessment including lipid profile, HbA1C, microalbuminuria. Patients were subjected to myocardial perfusion imaging [(MPI) study using 2 day (stress-rest) protocol patients were injected 25 mCi Tc99m sestaMIBI intravenously at peak of stress. Rest study was acquired in a separate day. Gated SPECT was acquired 30-60 minute post-stress for estimation of LVEDV, LVESV and LVEF. Processing and analysis were done to get the classic short axis, vertical long axis and horizontal long axis slices with application of 20 segment scoring system for semiquantitative analysis of defect size to get summed stress score (SSS), summed rest score(SRS),and summed difference score (SDS). The study was interpreted as negative when SSS = 0-3, mild (SSS>3& <8), moderate (SSS=8 &<12), and severe >12)]. Results: Patients were subdivided into two groups; Group1 (Diabetic): 24 pts and Group 2 (non Diabetic): 22 pts. Laboratory data showed comparable lipid profile in G1 vs G2; Serum cholesterol (196+58 vs. 200+58 mg/dl, p>0.05), triglycerides 163+66 vs. 187+90, p>0.05), HDL (45+14vs. 50+14, p>0.05) & LDL (127+48vs 135+44, p>0.05). HbA1c level was 9+3% in G1 vs 7+2 in G2, p=0.01 and was abnormal in 19 pts of G1 vs. 10 pts in G2, p=0.03. Microalbuminuria was detected in 13/24 pts of G1 vs 6/22 pts in G2. Mean exercise duration was 7+3 min in G1 vs 7+2 minutes in G2 P>0.05, mean Mets achieved was 10.6+3 vs 9.4+2 in G2, P > 0.05. Myocardial perfusion imaging was interpreted as positive in 41% of all pts (19 pts) (46% in G1 vs. 36% of G2), Six pts had mild ischemia (4 diabetics), Nine had moderate ischemia (4 diabetics) and 4pts had severe ischemia (3 diabetics [75%]), Mean SSS, SRS,& SDS were comparable (4.7+4vs 3.6+4, (0.3+1.6 vs 0.2+0.9),& (4.4+4 vs 3.4+3.7%) in G1vs G2 respectively. left ventricular ejection fraction, LVEDV and LVESV were comparable in G1vs G2 (68.1+10.8% vs 70.6+8.2%, P = 0.3), (103+24 vs 97+17, P = 0.3) & (32+16 vs 28+12, P = 0.4).Neither microalbuminuria nor HbA1c abnormality correlated with severity or abnormality of MPI. Conclusion: Preliminary data from our ongoing study suggest high incidence of silent ischemia in patient with type II diabetes mellitus and non diabetic patients with other risk factors for CAD in our developing country, with tendency of more severe ischemia and higher post-stress LV volumes in diabetic patients.
[Akram Abd Elbary; Mohamed Khaled; Mohga Said, Hala Zakaria, Lamiaa Hamed, Shaban Mohamed and Alia Abd El-Fattah. Assessment of Ischemia in Asymptomatic Type II Diabetics versus Asymptomatic patients with other Risk Factors of Coronary Artery Disease. Preliminary Data from GSPECT Tc99m sestaMIBI Myocardial Perfusion Imaging Study in Egyptian Patients. Life Sci J 2012;9(1):727-732]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 105
Key Words: Diabetics, Coronary Artery Disease, sestaMIBI, Myocardial Perfusion Imaging Full Text 105