What is the clinical evidence from this study?

Study design: Observational. Population: Type 2 diabetes mellitus with suspected coronary artery disease (n=73). Intervention: SPECT Myocardial perfusion imaging (MPI) vs. Non-diabetic asymptomatic patients. Primary outcome: Major cardiac events (cardiac death, nonfatal myocardial infarction, and coronary revascularization) (p=0.240).

April 1, 2026Open Access

Myocardial perfusion imaging findings and 2-year outcomes in clinically referred asymptomatic patients with type 2 diabetes

Key Result

Myocardial perfusion imaging in asymptomatic patients with type 2 diabetes revealed abnormal perfusion in 18.9% of cases, but the 2-year incidence of major cardiac events was low at 8.1% with no significant difference compared to non-diabetic controls.

Key Points

The central aim is to evaluate the association between myocardial perfusion imaging findings and 2-year cardiac outcomes in asymptomatic patients with type 2 diabetes.
Prospective observational study design
Included 198 outpatients referred for stress-rest SPECT imaging
Participants classified as asymptomatic based on clinical interviews
Followed for 24 months for cardiac events
Event-free survival analyzed using Kaplan–Meier methodology.
Myocardial perfusion abnormalities detected in 18.9% of diabetic and 22.2% of nondiabetic asymptomatic patients
Inducible ischemia present in 8.1% of diabetic and 8.3% of nondiabetic participants
Three cardiac events occurred in the diabetic group during follow-up, including one cardiac death
No cardiac events occurred in the nondiabetic group
No significant difference in event-free survival between the two groups.

Study Design

Type

Observational (n=73)

Multicenter

Structured PICO

Does routine myocardial perfusion imaging provide prognostic value for major cardiac events in clinically referred asymptomatic patients with type 2 diabetes?

Population

198 consecutive outpatients referred for stress-rest SPECT myocardial perfusion imaging due to intermediate clinical suspicion of coronary artery disease, from which a subgroup of 73 asymptomatic patients (37 with type 2 diabetes, 36 without diabetes) was analyzed. Mean age ~62-63 years, ~56% male. Key exclusions: known history of CAD, typical anginal symptoms, HFrEF with LVEF <40%, significant valvular heart disease.

Intervention

Stress-rest SPECT myocardial perfusion imaging (pharmacologic stress with intravenous dipyridamole 0.56 mg/kg) in asymptomatic patients with type 2 diabetes

Comparator

Asymptomatic patients without diabetes undergoing the same SPECT myocardial perfusion imaging protocol

Outcome

Major cardiac events (composite of cardiac death, nonfatal myocardial infarction, and coronary revascularization) at approximately 24 months follow-upcomposite

Routine myocardial perfusion imaging in unselected asymptomatic patients with type 2 diabetes has limited short-term prognostic value due to low overall cardiac event rates.

Main Result

Absolute Event Rate: 8.1% vs 0%

p-value: p=0.240

Limitations

Selected cohort referred based on clinical judgment rather than a general asymptomatic population
Small sample size of the asymptomatic cohort (n=73)
Very low number of cardiac events precluding multivariable adjustment and stable estimation of hazard ratios
Attenuation correction was not applied, potentially leading to false-positive perfusion defects
Single-center design limiting generalizability
Short follow-up duration of 24 months

Abstract

pstrongIntroduction. /strongType 2 diabetes mellitus is associated with an increased risk of coronary artery disease, which frequently remains clinically silent. Myocardial perfusion imaging with single-photon emission computed tomography is widely used for the detection of myocardial ischemia and risk stratification, but its prognostic value in asymptomatic diabetic patients remains uncertain. The aim of this prospective study was to evaluate myocardial perfusion imaging findings and 2-year cardiac outcomes in clinically referred asymptomatic patients with type 2 diabetes.br /strongMethods./strong This prospective observational study included 198 consecutive outpatients referred for stressrest SPECT myocardial perfusion imaging because of intermediate clinical suspicion of coronary artery disease. The study population consisted of 98 patients with type 2 diabetes and 100 patients without diabetes. Among them, 73 participants were classified as asymptomatic based on structured clinical interviews (37 diabetic and 36 nondiabetic patients). Myocardialnbsp;br /perfusion abnormalities were defined as a summed stress score ge;4, while inducible ischemia was defined as a summed difference score ge;2. Participants were followed for approximately 24 months for the occurrence of cardiac events including cardiac death, nonfatal myocardial infarction, and coronary revascularization. Eventfree survival was analyzed using Kaplanndash;Meier methodology.br /strongResults./strong Abnormal myocardial perfusion (SSS ge;4) was detected in 18.9% of asymptomatic diabetic patients and 22.2% of asymptomatic nondiabetic patients (p = 0.727). Inducible ischemia (SDS ge;2) was present in 8.1% and 8.3% of participants, respectively (p = 0.98). During the twoyear followup period, three cardiac events occurred in the diabetic group (8.1%), including one cardiac death and two coronary revascularizations, while no events occurred in nondiabeticnbsp;br /participants (p = 0.240). Kaplanndash;Meier analysis demonstrated no statistically significant difference in eventfree survival between diabetic and nondiabetic groups (logrank p = 0.083).br /strongConclusions./strong Myocardial perfusion abnormalities were relatively frequent in clinically referred asymptomatic patients with type 2 diabetes; however, shortterm cardiac event rates were low. These findings suggest limited prognostic value of routine myocardial perfusion imaging in unselected asymptomatic diabetic populations and support a selective approach to noninvasive testing./p

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