Myocardial Perfusion Scintigraphy in Detection of Myocardial Ischemia and Therapy Planning in Early Stages of Diabetes Mellitus

Patients with diabetes mellitus (DM) develop complications including coronary artery disease (CAD), which is the leading cause of mortality in this group of patients. One of the diagnostic modalities for early detection of myocardial ischemia in symptomatic and asymptomatic patients with DM is myocardial perfusion tomography (MPI). The aim of this study was to determine the usefulness of MPI in detection of myocardial ischemia in symptomatic and asymptomatic patients in early stages of DM. Thirty-four patients with DM, aged from 24 to 65 years, nine women and fifteen men were examined. Thirteen patients were CAD symptomatic, and 21 were asymptomatic. MPI was performed through a standard two-day protocol, and findings were categorized as normal perfusion, reversible perfusion defect (ischemia), and fixed perfusion defect (scar). Patients with ischemia were elected for coronary angiography (CAG). MPI and CAG findings were statistically analyzed. Fifteen (44,12%) patients had normal left ventricle perfusion, while 19 (55,88%) patients had perfusion defects. Scar was found in one patient, and ischemia in 18 patients. CAG showed stenosis of coronary artery in 7 (36,84%) of 19 patients with perfusion defects on MPI. Statistical analysis showed no correlation between MPI ischemia and stenosis on CAG. Discrepancy between ischemia on MPI and CAG presentations of epicardial coronary arteries is related to endothelial dysfunction rather than atherosclerosis. These patients benefit more from pharmacological therapy than from revascularization. MPI and CAG should be reserved for individuals with high risk of CAD.