NUCLEAR CARDIOLOGY IN THE MANAGEMENT OF HEART DISEASE IN DIABETES
Ronald G Schwartz
Preventive Nuclear Cardiology, University of Rochester Medical Center,
Rochester, NY, USA
Diabetes mellitus confers 2 to 4 fold incremental risk of adverse clinical
cardiovascular events Cardiac radionuclide tomographic perfusion and
function imaging provides incremental diagnostic and prognostic value in
diabetic and non-diabetic patients with known or suspected ischemic heart
disease, and provides insight into the therapeutic effectiveness of medical
and mechanical interventions The ability of SPECT and PET MPS to
characterize the presence of CAD in asymptomatic diabetic patients, as
demonstrated recently in the Detection of Ischemia in Asymptomatic Diabetes
DIAD study, if confirmed by outcome evidence in this population, may
shift the paradigm of CAD detection to evaluating other types of high risk
asymptomatic patient groups such as patients with history of a primarly
family member with CAD, multiple coronary risk factors, and patients with
renal and inflammatory diseases The threshold risk beyond which cost
effectiveness of
evaluating the high risk asymptomatic patient with SPECT
and PET MPS requires definition The reassurance value of a normal SPECT or
PET MPS study with normal LV volume and function requires further careful
study If very low risk of events in diabetic patients with normal MPS, LV
volume and performance is confirmed, new paradigms may be indicated for
optimizing cost effectiveness of allocating medical interventions and
resources to reduce the global ischemic burden of patients with diabetes
mellitus
Source:cardiologyonline.com
