Evaluation of myocardial perfussion by myocardial perfussion scintigraphy in patients with type 2 Diabetes mellitus

The aim of this study was to determine the prevalance of myocardialperfusion defects by using myocardial perfusion scintigrapy (MPS) in diabeticpatients without known coronary artery disease and to define clinicalcharacteristics of the patients which concerned perfusion defects.One hundred twenty-five type 2 diabetes mellitus (type 2 DM) patients ( 65women, 60 men) were included in the study. The mean age of the patients was56.0±9.0 years and the mean duration of diabetes was 8.6±7.2 years. Majorcardiovascular risk factors (hypertension, dyslipidaemia, smoking, obesity),diabetic complications and with or without chest pain were investigated. Forty-seven (37.6%) patients had chest pain history, 47 (37.6%) patients had gooddiabetic control (glycosylated haemoglobin values <7), 24 (19.2%) patients haddiabetic neuropathy and 77 (61.6%) patients had hypertension.We performed a conventional one-day protocol, using Tc-99m MIBI (296MBq for rest, 814 MBq for stress), by using a dual headed gamma camera(Infinia , GE, Tirat, Hacermel, Israel) with low energy, high resolution parallelhole collimators. Visual analysis of rest and stress images were made from shortaxis, horizontal long axis and vertical long axis views. For quantitative analysiswe used polar maps using the Emory Cardiac Toolbox software (EmoryUniversity, Atlanta, GA, USA).MPS were abnormal in 42.4% of the patients. Reversible perfusion defectswere observed in 40% of the patients, which were mild in 21.6% and moderateto severe in 18.4%. Fix defects were observed in 2.4% of the patients.Abnormal MPS results were seen in a high frequency (42%). There was nodifference between the groups with or without a history of chest pain in the rateof abnormal MPS. Patients with normal MPS and patients with abnormal MPSdid not differ with regard to glycosylated haemoglobin (Hb A1c) values (p>0.05).Abnormal MPS was associated with hypertension (p=0.04) and age (p=0.008).Reversible perfusion defects were associated with neuropathy (p=0.04).Moderate to severe reversible perfusion defects were associated withneuropathy (p=0.001) and longer diabetic duration (p=0.01). In the follow up ofthe patients, percutaneous coronary angiograpy (PTCA) was performed to 19patients, percutaneous coronary interventions (PCI) were done to 8 patients,coronary artery bypass graft surgery was made to one patient. Ten patients thathad 30-40% stenoses were treated medically and followed up.As a result, early diagnosis of ischemic heart diseases in diabetic patientscould be made by using MPS. Early treatment of these patients can improve thelife quality and prolonge the survival rate.