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J Diabetes Complications. 2014 May-Jun;28(3):413-8. doi: 10.1016/j.jdiacomp.2013.11.013. Epub 2013 Dec 10.

Silent myocardial ischemia detected by single photon emission computed tomography (SPECT) and risk of cardiac events among asymptomatic patients with type 2 diabetes: a meta-analysis of prospective studies.

Author information

1
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China; Department of Geriatrics, The First Affiliated Hospital, Kunming Medical University, Kunming, China.
2
Department of Endocrinology and Metabolism, The First Affiliated Hospital, Kunming Medical University, Kunming, China.
3
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
4
Department of Nutrition, The University of North Carolina, Chapel Hill, NC, USA.
5
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China. Electronic address: jiln@bjmu.edu.cn.

Abstract

OBJECTIVE:

To assess the value of detecting silent myocardial ischemia (SMI) by single photon emission computed tomography (SPECT) in predicting risk of cardiac events among patients with type 2 diabetes mellitus (T2DM) who do not have overt cardiac symptoms.

MATERIALS AND METHODS:

Electronic databases (PubMed, Cochrane Library, EMBASE, and others) and original article references were systematically searched through February 1, 2013. A fixed-effects model was applied to pooled data to estimate relative risks (RR) and 95% confidence intervals (CI).

RESULTS:

Ten prospective studies with follow-up ranging from 1 to 6 years were identified. Among the total of 1360 asymptomatic patients with T2DM screened by SPECT, the cumulative prevalence rate of SMI was 26.1%. Patients with SMI were at increased risk of experiencing endpoints relative to patients without SMI: RR (95% CI) for cardiac death, 4.60 (1.78-11.84); non-fatal cardiac events, 3.48 (2.30-5.28); total cardiac events, 3.48 (2.59-4.68); and all-cause mortality, 2.20 (1.14-4.25). The risk of cardiac death and non-fatal cardiac events increased with increasing severity of SPECT-detected abnormalities.

CONCLUSIONS:

SMI detected by SPECT is associated with increased risk of cardiac death, all-cause mortality, and non-fatal cardiac events in T2DM patients without overt cardiac symptoms. Advanced intervention procedures including intensive drug management should be implemented to reduce the risk of cardiac events for SMI-positive T2DM patients.

KEYWORDS:

Meta-analysis; Silent myocardial ischemia; Single photon emission computed tomography (SPECT); Type 2 diabetes

PMID:
24529748
DOI:
10.1016/j.jdiacomp.2013.11.013
[Indexed for MEDLINE]
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