In the Journals

Diabetes, minimal perfusion deficit increase risk for major adverse CV events

Even a small perfusion deficit substantially amplifies risk for major adverse cardiovascular events among adults with diabetes vs. those without, according to findings published in Diabetes Care.

Patients with diabetes were found to have a higher risk for major adverse CV events than patients without across all categories of quantitative perfusion abnormality,” Piotr J. Slomka, PhD, of the division of nuclear medicine in the departments of imaging, medicine and biomedical sciences at Cedars-Sinai Medical Center in Los Angeles, and colleagues wrote. “Patients with diabetes were found to have increased major adverse CV event risk even with the most minimal quantitative perfusion defects. Patients with diabetes with minimal ischemia had comparable major adverse CV event risk as patients without diabetes with significant ischemia.”

Examining major adverse CV events

Slomka and colleagues analyzed single-photon emission CT myocardial perfusion imaging readings from 2,951 adults with diabetes (mean age, 64 years; 49% women) to determine total perfusion deficit (TPD) percentages. The researchers then assessed instances of death, myocardial infarction, unstable angina and late revascularization across a median follow-up time of 4.6 years in this population and a propensity-matched population of adults who did not have diabetes (mean age, 65 years; 49% women).

A larger proportion of the adults with diabetes experienced a major adverse CV event vs. those who did not have diabetes (16% vs. 10%; P < .001). A total of 225 individuals with diabetes and 173 without had a moderate to severe TPD (more than 10%; (P = .007), and there were similar numbers of individuals in the two groups for TPDs of 5% to 10% (mild), 1% to less than 5% (minimal), more than 0% but less than 1% (very minimal) and 0% (no deficit).

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Even a small perfusion deficit substantially amplifies risk for major adverse cardiovascular events among adults with diabetes vs. those without.

Adults with diabetes and moderate to severe (9.4% vs. 3.9%; P < .001), mild (4.6% vs. 3.2%; P = .031), minimal (3.2% vs. 2.1%; P = .001) and very minimal (2.4% vs. 1.4%; P = .004) TPDs had higher annual major adverse CV event rates vs. adults without diabetes and similar TPD measures.

‘Greater myocardial ischemic burden’

Adults with diabetes and moderate to severe (HR = 6.15; 95% CI, 3.61-10.48), mild (HR = 3.43; 95% CI, 2.02-5.83), minimal (HR = 2.6; 95% CI, 1.58-4.28) and very minimal TPDs (HR = 2.08; 95% CI, 1.23-3.53) had larger major adverse CV event risks than those with diabetes and no TPD. Meanwhile, adults with no diabetes and moderate to severe (HR = 2.59; 95% CI, 1.37-4.9) and mild TPDs (HR = 2.16; 95% CI, 1.21-3.88) had larger major adverse CV event risks than those without diabetes and no TPD.

“Patients with diabetes with minimal TPD had comparable major adverse CV event risk as patients without diabetes with significant TPD,” the researchers wrote. “Therefore, patients with diabetes with even minimal perfusion defect may require medical attention, and those patients could be managed as if they had significant perfusion defects.”

The hazard ratios calculated when comparing adults with diabetes and any TPD vs. adults without diabetes and any TPD indicated that those with diabetes had heightened risk, according to the researchers, who noted similar findings for those with very minimal (HR = 1.68; 95% CI, 1.17-2.4), minimal (HR = 1.45; 95% CI, 1.03-2.03), mild (HR = 1.56; 95% CI, 1.26-1.94) and moderate to severe TPDs (HR = 2.35; 95% CI, 1.55-3.54).

“This suggests that patients with diabetes are more vulnerable to a greater myocardial ischemic burden than patients without diabetes are, even if they have similar risk factors,” the researchers wrote. – by Phil Neuffer

Disclosures: Slomka reports he has participated in software royalties for Quantitative Perfusion SPECT software and received research support from Siemens Medical Systems. Please see the study for all other authors’ relevant financial disclosures.

Even a small perfusion deficit substantially amplifies risk for major adverse cardiovascular events among adults with diabetes vs. those without, according to findings published in Diabetes Care.

Patients with diabetes were found to have a higher risk for major adverse CV events than patients without across all categories of quantitative perfusion abnormality,” Piotr J. Slomka, PhD, of the division of nuclear medicine in the departments of imaging, medicine and biomedical sciences at Cedars-Sinai Medical Center in Los Angeles, and colleagues wrote. “Patients with diabetes were found to have increased major adverse CV event risk even with the most minimal quantitative perfusion defects. Patients with diabetes with minimal ischemia had comparable major adverse CV event risk as patients without diabetes with significant ischemia.”

Examining major adverse CV events

Slomka and colleagues analyzed single-photon emission CT myocardial perfusion imaging readings from 2,951 adults with diabetes (mean age, 64 years; 49% women) to determine total perfusion deficit (TPD) percentages. The researchers then assessed instances of death, myocardial infarction, unstable angina and late revascularization across a median follow-up time of 4.6 years in this population and a propensity-matched population of adults who did not have diabetes (mean age, 65 years; 49% women).

A larger proportion of the adults with diabetes experienced a major adverse CV event vs. those who did not have diabetes (16% vs. 10%; P < .001). A total of 225 individuals with diabetes and 173 without had a moderate to severe TPD (more than 10%; (P = .007), and there were similar numbers of individuals in the two groups for TPDs of 5% to 10% (mild), 1% to less than 5% (minimal), more than 0% but less than 1% (very minimal) and 0% (no deficit).

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Even a small perfusion deficit substantially amplifies risk for major adverse cardiovascular events among adults with diabetes vs. those without.

Adults with diabetes and moderate to severe (9.4% vs. 3.9%; P < .001), mild (4.6% vs. 3.2%; P = .031), minimal (3.2% vs. 2.1%; P = .001) and very minimal (2.4% vs. 1.4%; P = .004) TPDs had higher annual major adverse CV event rates vs. adults without diabetes and similar TPD measures.

‘Greater myocardial ischemic burden’

Adults with diabetes and moderate to severe (HR = 6.15; 95% CI, 3.61-10.48), mild (HR = 3.43; 95% CI, 2.02-5.83), minimal (HR = 2.6; 95% CI, 1.58-4.28) and very minimal TPDs (HR = 2.08; 95% CI, 1.23-3.53) had larger major adverse CV event risks than those with diabetes and no TPD. Meanwhile, adults with no diabetes and moderate to severe (HR = 2.59; 95% CI, 1.37-4.9) and mild TPDs (HR = 2.16; 95% CI, 1.21-3.88) had larger major adverse CV event risks than those without diabetes and no TPD.

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“Patients with diabetes with minimal TPD had comparable major adverse CV event risk as patients without diabetes with significant TPD,” the researchers wrote. “Therefore, patients with diabetes with even minimal perfusion defect may require medical attention, and those patients could be managed as if they had significant perfusion defects.”

The hazard ratios calculated when comparing adults with diabetes and any TPD vs. adults without diabetes and any TPD indicated that those with diabetes had heightened risk, according to the researchers, who noted similar findings for those with very minimal (HR = 1.68; 95% CI, 1.17-2.4), minimal (HR = 1.45; 95% CI, 1.03-2.03), mild (HR = 1.56; 95% CI, 1.26-1.94) and moderate to severe TPDs (HR = 2.35; 95% CI, 1.55-3.54).

“This suggests that patients with diabetes are more vulnerable to a greater myocardial ischemic burden than patients without diabetes are, even if they have similar risk factors,” the researchers wrote. – by Phil Neuffer

Disclosures: Slomka reports he has participated in software royalties for Quantitative Perfusion SPECT software and received research support from Siemens Medical Systems. Please see the study for all other authors’ relevant financial disclosures.