Assessment of asymptomatic ischemic heart disease using stress myocardial perfusion imaging in patients with type 2 diabetes mellitus

BACKGROUND: Coronary artery disease (CAD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM) and may be asymptomatic. OBJECTIVE: The objective of this study was to assess the prevalence of asymptomatic myocardial ischemia in patients with T2DM using stress myocardial perfusion imaging. METHODS: We evaluated 97 consecutive patients with T2DM without clinical evidence of CAD presenting to Cardiology and Endocrinology clinics using Tc-99m MIBI gated single-photon emission-computed tomography (SPECT) myocardial perfusion imaging for the presence of asymptomatic CAD. RESULTS: Abnormal myocardial perfusion was observed in 10 patients (10.3%). Of these, one half of patients had reversible myocardial perfusion defects suggestive of inducible myocardial ischemia. The other half had fixed perfusion defects suggestive of previous silent myocardial infarctions. Small and moderate reversible perfusion defects were observed in 3 and 2 patients, respectively. The fixed perfusion defects observed in 5 patients were medium sized. The presence of asymptomatic ischemia was significantly associated with age and smoking but not with other traditional cardiac risk factors. CONCLUSION: Ten percent of patients with T2DM with no clinical evidence of CAD were found to have evidence of asymptomatic ischemia or infarction.