SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY OF TECHNETIUM-99M TETROFOSMIN MYOCARDIAL PERFUSION IMAGING AND DETECTION OF SILENT MYOCARDIAL ISCHEMIA IN DIABETIC PATIENTS

Abstract: Diabetes is associated with more extensive coronary artery disease and an increased risk of cardiac death ,so the aim of this study was to evaluate the utility of single-photon emission computed tomography (SPECT) of teclinetium-99m tetrofosmin (Tc-99m TF) myocardial perfusion imaging to detect myocardial involvement in patients with diabetes mellitus. Patients and Methods: Three groups of subjects-group A: 85 non diabetic patients with non-specific cardiac symptoms and signs, and group B (diabetic) 90 cases were evaluated. Group B was subdivided into pro up Bl: 50 type I diabetic patients, and group B2: 40 type 2 diabetic patients- Both Bl and B2 had no cardiac symptoms and signs. All cases were evaluated by comparing rest and stress Tc-99m TF myocardial perfusion SPECT together with laboratory investigations and clinical examination. Results:Tc-99m TF myocardial perfusion SPECT revealed perfusion defects in 18.8% and 55.6% of the cases in groups A and B, respectively. A significant association was found between SMI in type 1 and family history of CAD, PAD, sex, LDL cholesterol, microangiopathy, and non-HDL cholesterol. In multivariate analysis, family history of CAD (odds ratio [OR] 6.9, P = 0.003), PAD (3.6. P = 0.023), and microangiopathy (3.4, P = 0.018) were found to be significant independent predictors for SMI. In Type 2 DM, LDL cholesterol levels were significantly higher and HDL cholesterol levels lower in comparison to the non diabetic group (P = 0.033 and P = 0.005, respectively). Patients in type 2 group were also more frequently affected by PAD than those in the non diabetic group (P 0.05) and type 1DM (P 0.05). Coiiclusioii:Tc-99in TF myocardial perfusion SPECT is a useful noninvasive imaging modality lo detect cardiac involvement in diabetic patients with or without cardiac symptoms and signs.