Muhammad Naeem Aslam, Muhammad Shahzad Afzal, Humera Javad, Muhammad Babar Imran, Muhammad Sarfraz, Javaid Irfanullah.
Role of Myocardial Perfusion Scintigraphy in Diabetics patients: detection of Myocardial Ischemia in asymptomatic subjects or those with atypical presentation.
Pak J Cardiol Jan ;15(1):3-11.

Back Ground. Coronary artery disease is a major cause of morbidity and mortality in patients with diabetes and this population has high incidence of silent cardiac events. We evaluated the role of myocardial perfusion scintigraphy (MPS) in detection of coronary artery disease (CAD) in population of diabetic patients who are either asymptomatic or having atypical presentation. Material and Methods. We studied 266 consecutive known diabetes type 11 patients who at the time of cardiac SPECT (single photon emission computed tomography) perfusion scan were either asymptomatic or having atypical chest pain. Patients with prior history of myocardial infarction, typical effort angina, coronary angiography, percutaneous coronary intervention or bypass surgery were excluded. Their age ranged from 29 to 77 years, 105 being male and 161 female. Their duration since diagnosis of diabetes mellitus ranged from 1 to 20 years (average=5.85 ± 4.56 years). Upon the bases of clinical history, patients were divided into two groups; Group A (n=152) consisted of asymptomatic diabetic subjects and group B (n=114) 14) comprised of diabetics with atypical presentation. SPECT Myocardial perfusion scintigraphy with 201T1 thallous chloride was performed in every subject. Results. Considering all diabetic patients together, 47.4% were having normal myocardial perfusion scintigraphy, 40.6% diagnosed as cases of inducible ischemia, while 12% subjects were having myocardial infarction. In group A (asymptomatic diabetic patients), 53.9% were normal, and 46.1 % having coronary artery disease. Among the asymptomatic diabetic patients with CAD, 80% were having inducible ischemia, and 20% myocardial infarction. In Group B (diabetic patients with atypical chest pain), 38.6% were normal and 61.4% having coronary artery disease. Among diabetic patients with atypical chest pain and positive myocardial perfusion scintigraphy for coronary artery disease, 74.3% were having inducible ischemia and 25.7% myocardial infarction Conclusion: Our study concludes that incidence of ischemic heart disease in diabetic patients, who are either asymptomatic or having atypical presentation, is very high. Based on our findings every second patient of type 2 diabetes mellitus has silent myocardial ischemia/ infarction. Hence routine screening for silent myocardial ischemia in diabetics is of extreme importance.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com