Key result
Mild renal dysfunction in asymptomatic diabetic patients was associated with a 4.55% 3-year incidence of cardiac events vs 1.52% with good renal function, and MPI predicted risk only in the former.
Why the study?
Does myocardial perfusion imaging (MPI) predict 3-year cardiac events in asymptomatic Japanese patients with type 2 diabetes and mild renal dysfunction?
Cohort (n=286)
Does myocardial perfusion imaging (MPI) predict 3-year cardiac events in asymptomatic Japanese patients with type 2 diabetes and mild renal dysfunction?
Absolute Event Rate: 4.55% vs 1.52%
Myocardial perfusion imaging provides prognostic value for predicting 3-year cardiac events in asymptomatic diabetic patients with mild renal dysfunction, but may be unnecessary for those with preserved renal function.
MPI may stratify risk in asymptomatic diabetics with mild renal dysfunction; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Diabetes is frequently accompanied by chronic kidney disease, and both diabetes and chronic kidney disease are risk factors for ischemic heart disease; however, cardiac risk among diabetic patients with mild renal dysfunction has not been analyzed in detail. The present study investigates how myocardial perfusion imaging (MPI) contributes to the risk stratification of diabetic patients with mild renal dysfunction who are asymptomatic for cardiac diseases. PATIENTS AND METHODS: Among 513 asymptomatic patients with type 2 diabetes in the Japanese Assessment of Cardiac Events and Survival Study 2 (J-ACCESS) database, we selected 286 with estimated glomerular filtration rates (eGFR) of at least 45 ml/min/1.73 m and assigned them to groups on the basis of eGFR of at least 60 without (group A, n=66) or with microalbuminuria or eGFR 45 to less than 60 (group B, n=220). The 3-year incidence of cardiac events and the value of MPI were evaluated. RESULTS: Cardiac events developed in 1.52 and 4.55% of patients in groups A and B, respectively. Event-free survival did not differ according to summed stress scores in group A but was significantly lower among patients with summed stress scores of at least 9 in group B. CONCLUSION: Routine MPI might be useful for stratifying risk among diabetic patients with mild renal dysfunction but is unnecessary for those with good renal function.
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Okuyama et al. (2013) conducted a cohort in Type 2 diabetes with mild renal dysfunction (n=286). Mild renal dysfunction (eGFR 45 to <60 or microalbuminuria) vs. Good renal function (eGFR ≥60 without microalbuminuria) was evaluated on 3-year incidence of cardiac events. Mild renal dysfunction in asymptomatic diabetic patients was associated with a 4.55% 3-year incidence of cardiac events vs 1.52% with good renal function, and MPI predicted risk only in the former.
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