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Kiso K, Nakajima K, Nimura Y, Nishimura T. A novel algorithm developed using machine learning and a J-ACCESS database can estimate defect scores from myocardial perfusion single-photon emission tomography images. Ann Nucl Med 2024:10.1007/s12149-024-01971-z. [PMID: 39210200 DOI: 10.1007/s12149-024-01971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Stress myocardial perfusion single-photon emission computed tomography (SPECT) imaging (MPI) has been used to diagnose and predict the prognoses of patients with coronary artery disease (CAD). An ongoing multicenter collaboration established a Japanese database (J-ACCESS) in 2001 that includes a risk model and expert interpretations. The present study aimed to develop a novel algorithm using machine learning (ML) and resources from the J-ACCESS database to aid SPECT image interpretation. METHODS We analyzed data from 1288 patients in J-ACCESS 3 and 4 databases. Three-dimensional (3D) stereoscopic images of left ventricular myocardial perfusion were reconstructed with linear transformation from the original short-axis data. Segments were extracted from U-Net, then features were extracted from each segment during the ML process. We estimated segmental scores based on weighted features obtained from fully connected layers. Correlations between segment scores interpreted by nuclear cardiology experts and estimated by ML were evaluated using a 17-segment model, summed stress (SSS), summed rest (SRS), and summed difference (SDS) scores, and ratios (%) of summed different scores (%SDS). RESULTS The complete concordance rate of scores assessed by the experts and estimated by ML was 79.6%. The underestimated and overestimated rates were 10.3% and 10.0%, respectively. Associations between defect scores assessed by experts and ML were close, with correlation coefficients (r) of 0.923, 0.917, 0.842 and 0.853 for SSS, SRS, SDS, %SDS, respectively (p < 0.0001 for all). CONCLUSIONS We created a new algorithm to estimate MPI scores using ML and the J-ACCESS database. This algorithm should provide accurate MPI interpretation even in facilities without specialist nuclear cardiologists, and might facilitate therapeutic decision-making and predict prognoses.
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Affiliation(s)
- Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
- Department of Radiology, Sendai Medical Imaging Center, Sendai, Japan.
| | - Kenichi Nakajima
- Department of Nuclear Medicine/Functional Imaging and Artificial Intelligence, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920‑8640, Japan.
| | | | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Yang CC, Peng CH, Huang LY, Chen FY, Kuo CH, Wu CZ, Hsia TL, Lin CY. Comparison between multiple logistic regression and machine learning methods in prediction of abnormal thallium scans in type 2 diabetes. World J Clin Cases 2023; 11:7951-7964. [DOI: 10.12998/wjcc.v11.i33.7951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/23/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes (T2D) has been increasing dramatically in recent decades, and 47.5% of T2D patients will die of cardiovascular disease. Thallium-201 myocardial perfusion scan (MPS) is a precise and non-invasive method to detect coronary artery disease (CAD). Most previous studies used traditional logistic regression (LGR) to evaluate the risks for abnormal CAD. Rapidly developing machine learning (Mach-L) techniques could potentially outperform LGR in capturing non-linear relationships.
AIM To aims were: (1) Compare the accuracy of Mach-L methods and LGR; and (2) Found the most important factors for abnormal TMPS.
METHODS 556 T2D were enrolled in the study (287 men and 269 women). Demographic and biochemistry data were used as independent variables and the sum of stressed score derived from MPS scan was the dependent variable. Subjects with a MPS score ≥ 9 were defined as abnormal. In addition to traditional LGR, classification and regression tree (CART), random forest, Naïve Bayes, and eXtreme gradient boosting were also applied. Sensitivity, specificity, accuracy and area under the receiver operation curve were used to evaluate the respective accuracy of LGR and Mach-L methods.
RESULTS Except for CART, the other Mach-L methods outperformed LGR, with gender, body mass index, age, low-density lipoprotein cholesterol, glycated hemoglobin and smoking emerging as the most important factors to predict abnormal MPS.
CONCLUSION Four Mach-L methods are found to outperform LGR in predicting abnormal TMPS in Chinese T2D, with the most important risk factors being gender, body mass index, age, low-density lipoprotein cholesterol, glycated hemoglobin and smoking.
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Affiliation(s)
- Chung-Chi Yang
- Division of Cardiovascular Medicine, Taoyuan Armed Forces General Hospital, Taoyuan City 32551, Taiwan
- Division of Cardiovascular, Tri-service General Hospital, Taipei City 114202, Taiwan
| | - Chung-Hsin Peng
- Department of Urology, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
| | - Li-Ying Huang
- Department of Internal Medicine, Department of Medical Education, School of Medicine, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 243, Taiwan
| | - Fang Yu Chen
- Department of Endocrinology, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
| | - Chun-Heng Kuo
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 243, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
| | - Chung-Ze Wu
- Division of Endocrinology, Shuang Ho Hospital, New Taipei City 23561, Taiwan
- School of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
| | - Te-Lin Hsia
- Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
| | - Chung-Yu Lin
- Department of Cardiology, Fu Jen Catholic University Hospital, New Taipei City 24352, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242062, Taiwan
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Comparison between Machine Learning and Multiple Linear Regression to Identify Abnormal Thallium Myocardial Perfusion Scan in Chinese Type 2 Diabetes. Diagnostics (Basel) 2022; 12:diagnostics12071619. [PMID: 35885524 PMCID: PMC9324130 DOI: 10.3390/diagnostics12071619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) patients have a high risk of coronary artery disease (CAD). Thallium-201 myocardial perfusion scan (Th-201 scan) is a non-invasive and extensively used tool in recognizing CAD in clinical settings. In this study, we attempted to compare the predictive accuracy of evaluating abnormal Th-201 scans using traditional multiple linear regression (MLR) with four machine learning (ML) methods. From the study, we can determine whether ML surpasses traditional MLR and rank the clinical variables and compare them with previous reports.In total, 796 T2DM, including 368 men and 528 women, were enrolled. In addition to traditional MLR, classification and regression tree (CART), random forest (RF), stochastic gradient boosting (SGB) and eXtreme gradient boosting (XGBoost) were also used to analyze abnormal Th-201 scans. Stress sum score was used as the endpoint (dependent variable). Our findings show that all four root mean square errors of ML are smaller than with MLR, which implies that ML is more precise than MLR in determining abnormal Th-201 scans by using clinical parameters. The first seven factors, from the most important to the least are:body mass index, hemoglobin, age, glycated hemoglobin, Creatinine, systolic and diastolic blood pressure. In conclusion, ML is not inferior to traditional MLR in predicting abnormal Th-201 scans, and the most important factors are body mass index, hemoglobin, age, glycated hemoglobin, creatinine, systolic and diastolic blood pressure. ML methods are superior in these kinds of studies.
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Predictors of abnormality in thallium myocardial perfusion scans for type 2 diabetes. Heart Vessels 2020; 36:180-188. [PMID: 32816060 DOI: 10.1007/s00380-020-01681-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/14/2020] [Indexed: 12/19/2022]
Abstract
Type 2 diabetes mellitus (T2DM) increases coronary artery disease (CAD) risk. In this study, we used T2DM clinical variables to predict abnormality in thallium-201 myocardial perfusion scans (Th-201 scans). These clinical variables were summed stress score (SSS), summed rest score, and summed difference score (SDS), with data obtained from 368 male and 428 female participants with T2DM. Multiple linear regression results were as follows. In male participants, body mass index (BMI) and creatinine (Cr) were associated with SSS (β = 0.224, p < 0.001; β = 0.140, p = 0.022, respectively), and only BMI was associated with SDS (β = 0.174, p = 0.004). In female participants, BMI and high-density lipoprotein cholesterol level were associated with SSS (β = 0.240, p < 0.001; β = - 0.120, p = 0.048, respectively), and only BMI was correlated with SDS (β = 0.123, p = 0.031). Our multivariate logistic regression indicated that in male and female participants, BMI was the only independent indicator of high SSS (SSS ≥ 9). In this study, we demonstrated that male patients have a higher SSS and SDS than female patients do in Th-201 scans for T2DM in a Chinese population. For male and female patients, BMI was the strongest predictor of abnormality in Th-201 scans. Our results can help clinicians identify patients with T2DM at high risk of CAD.
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The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients. Cardiol Res Pract 2018; 2018:5128626. [PMID: 30425857 PMCID: PMC6218742 DOI: 10.1155/2018/5128626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/11/2018] [Accepted: 09/23/2018] [Indexed: 02/02/2023] Open
Abstract
Background It has been reported that harmonics of radial pulse is related to coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). It is still unclear whether or not the first harmonics of the radial pulse spectrum is an early independent predictor of silent coronary artery disease (SCAD) and adverse cardiac events (ACE). Objectives To measure the risk of SCAD in patients with T2DM and also to survey whether or not an increment of the first harmonic (C1) of the radial pulse increases ACE. Methods 1968 asymptomatic individuals with T2DM underwent radial pulse wave measurement. First harmonic of the radial pressure wave, C1, was calculated. Next, the new occurrence of ACE and the new symptoms and signs of coronary artery disease were recorded. The follow-up period lasted for 14.7 ± 3.5 months. Results Out of 1968 asymptomatic individuals with T2DM, ACE was detected in 239 (12%) of them during the follow-up period. The logrank test demonstrated that the cumulative incidence of ACE in patients with C1 above 0.96 was greater than that in those patients with C1 below 0.89 (P < 0.01). By comparing the data of patients with C1 smaller than the first quartile and the patients with C1 greater than the third quartile, the hazard ratios were listed as follows: ACE (hazard ratio, 2.29; 95% CI, 1.55–3.37), heart failure (hazard ratio, 2.22; 95% CI, 1.21–4.09), myocardial infarction (hazard ratio, 2.44; 95% CI, 1.51–3.93), left ventricular dysfunction (Hazard ratio, 2.01; 95% CI, 0.86–4.70), and new symptoms and signs for coronary artery disease (hazard ratio, 2.03; 95% CI, 1.45–2.84). As C1 increased, the risk for composite ACE (P < 0.001 for trend) and for coronary disease (P < 0.001 for trend) also increased. The hazard ratio and trend for cardiovascular-cause mortality were not significant. Conclusions This study showed that C1 of the radial pulse wave is correlated with cardiovascular events. Survival analysis showed that C1 value is an independent predictor of ACE and SCAD in asymptomatic patients with T2DM. Thus, screening for the first harmonic of the radial pulse may improve the risk stratification of cardiac events and SCAD in asymptomatic patients although they had no history of coronary artery disease or angina-related symptom.
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Kinoshita M, Yokote K, Arai H, Iida M, Ishigaki Y, Ishibashi S, Umemoto S, Egusa G, Ohmura H, Okamura T, Kihara S, Koba S, Saito I, Shoji T, Daida H, Tsukamoto K, Deguchi J, Dohi S, Dobashi K, Hamaguchi H, Hara M, Hiro T, Biro S, Fujioka Y, Maruyama C, Miyamoto Y, Murakami Y, Yokode M, Yoshida H, Rakugi H, Wakatsuki A, Yamashita S. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017. J Atheroscler Thromb 2018; 25:846-984. [PMID: 30135334 PMCID: PMC6143773 DOI: 10.5551/jat.gl2017] [Citation(s) in RCA: 511] [Impact Index Per Article: 85.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Koutaro Yokote
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Seiji Umemoto
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Hirotoshi Ohmura
- Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Shinji Kihara
- Biomedical Informatics, Osaka University, Osaka, Japan
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Isao Saito
- Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhisa Tsukamoto
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama, Japan
| | - Seitaro Dohi
- Chief Health Management Department, Mitsui Chemicals Inc., Tokyo, Japan
| | - Kazushige Dobashi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine, Kanagawa, Japan
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University, Hyogo, Japan
| | - Chizuko Maruyama
- Department of Food and Nutrition, Faculty of Human Sciences and Design, Japan Women's University, Tokyo, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Masayuki Yokode
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akihiko Wakatsuki
- Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan
| | - Shizuya Yamashita
- Department of Community Medicine, Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Rinku General Medical Center, Osaka, Japan
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Yoda S, Hori Y, Hayase M, Mineki T, Hatta T, Suzuki Y, Matsumoto N, Hirayama A. Correlation between early revascularization and major cardiac events demonstrated by ischemic myocardium in Japanese patients with stable coronary artery disease. J Cardiol 2017; 71:44-51. [PMID: 28732592 DOI: 10.1016/j.jjcc.2017.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no report on correlation between early revascularization and the occurrence of major cardiac events (MCEs) except severe heart failure in Japanese patients with stable coronary artery disease (CAD). This study aimed to determine whether early revascularization affected the incidence of MCEs in Japanese patients with stable CAD. METHODS We retrospectively investigated 3581 stable CAD patients who underwent rest 201Tl and stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography (SPECT) and provided three-year-prognostic data. The endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction, and unstable angina pectoris. On the basis of estimated propensity scores, patients who underwent revascularization within the first 60 days after the SPECT and those who did not were matched in a 1:1 ratio (n=450 per group). We compared MCE rates in relation to the amount of ischemic myocardium detected with the SPECT between the two groups. RESULTS The overall incidence of MCEs was not significantly different between the early-revascularization and no-early-revascularization groups (6.7% vs. 8.7%, p=0.2598). Nevertheless, the incidence of MCEs in the patients with ≤5% ischemia was significantly higher in the early-revascularization group than in the no-early-revascularization group (5.8% vs. 0.8%, p=0.0226). In contrast, the incidence of MCEs in the patients with >10% ischemia was significantly lower in the early-revascularization group than in the no-early-revascularization group (7.0% vs. 16.8%, p=0.0036). The incidence of MCEs in the patients with 6-10% ischemia, however, was not significantly different between the early-revascularization and no-early-revascularization groups (6.9% vs. 4.1%, p=0.3235). CONCLUSIONS Early revascularization possibly leads to the occurrence of MCEs related to the treatment procedure but may be a therapeutic strategy leading to improvement in prognosis in patients with moderate to severe ischemia.
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Affiliation(s)
- Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Mineki
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takumi Hatta
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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Yoda S, Nakanishi K, Tano A, Hori Y, Hayase M, Mineki T, Suzuki Y, Matsumoto N, Hirayama A. Prognostic Value of Major Cardiac Event Risk Score Estimated With Gated Myocardial Perfusion Imaging in Japanese Patients With Coronary Artery Disease. Int Heart J 2016; 57:408-16. [DOI: 10.1536/ihj.15-428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine
| | - Kanae Nakanishi
- Department of Cardiology, Nihon University School of Medicine
| | - Ayako Tano
- Department of Cardiology, Nihon University School of Medicine
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine
| | - Misa Hayase
- Department of Cardiology, Nihon University School of Medicine
| | - Takashi Mineki
- Department of Cardiology, Nihon University School of Medicine
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine
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Yoda S, Nakanishi K, Tano A, Hori Y, Suzuki Y, Matsumoto N, Hirayama A. Major cardiac event risk scores estimated with gated myocardial perfusion imaging in Japanese patients with coronary artery disease. J Cardiol 2015; 67:64-70. [PMID: 25982667 DOI: 10.1016/j.jjcc.2015.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 04/04/2015] [Accepted: 04/09/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND A Heart Risk Table has been reported as the first risk score based on nuclear cardiology to predict cardiac event rates in Japanese patients. However, there are no risk scores estimating risk of major cardiac events (MCEs) except severe heart failure. METHODS We retrospectively investigated 2579 patients with known or suspected coronary artery disease (CAD) who underwent rest (201)Tl and stress (99m)Tc-tetrofosmin myocardial perfusion single photon emission computed tomography between October 2004 and March 2011 and who had data on a 3-year follow-up. The perfusion images were analyzed with 20 segments of a five-point visual scoring model to estimate summed defect scores. The endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction and unstable angina pectoris. RESULTS During the 3-year follow-up, 171 patients (6.6%) experienced MCEs comprising cardiac death (n=78), non-fatal myocardial infarction (n=30), and unstable angina pectoris (n=63). The multivariate logistic regression analysis indicated age, diabetes, estimated glomerular filtration rate (eGFR), and summed stress scores (SSS) as independent predictors of the MCEs and age, stress ejection fraction, eGFR, and SSS as independent predictors of cardiac death. Those four predictors and coefficients corresponding to them were used to make two different risk equations: MCE risk (%/3 years)=1/{1+Exp[-(-3.176+0.018×age+0.602×diabetes-0.022×eGFR+0.051×SSS)]}×100 and cardiac death risk (%/3 years)=1/{1+Exp[-(-2.602+0.031×age-0.031×eGFR+0.038×SSS-0.029×stress ejection fraction)]}×100. CONCLUSION The risk scores obtained from this study are useful to predict MCEs in Japanese patients with CAD and are expected to be useful for management and informed consent of high-risk CAD patients.
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Affiliation(s)
- Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
| | - Kanae Nakanishi
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Ayako Tano
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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Yoda S, Nakanishi K, Tano A, Hori Y, Suzuki Y, Matsumoto N, Hirayama A. Significance of worsening renal function and nuclear cardiology for predicting cardiac death in patients with known or suspected coronary artery disease. J Cardiol 2015; 66:423-9. [PMID: 25703693 DOI: 10.1016/j.jjcc.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/28/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Estimated glomerular filtration rates (eGFRs) at baseline are useful to determine the severity of renal function and to predict cardiac events. However, no studies aimed to demonstrate significance of eGFRs measured during follow-up and usefulness of combination with nuclear cardiology for prediction of cardiac death in patients with coronary artery disease (CAD). METHODS We retrospectively investigated 1739 patients with known/suspected CAD who underwent myocardial perfusion single photon emission computed tomography (SPECT), who had eGFRs measured at baseline and after one year and who underwent a three-year follow-up. The SPECT images were analyzed with the visual scoring model to estimate summed defect scores. Reduction in eGFRs (ΔeGFR) was defined as the difference between eGFRs measured after one year and at baseline. The endpoint of the follow-up was cardiac deaths within three years after the SPECT, which were identified with medical records or responses to posted questionnaires. RESULTS Cardiac death was observed in 54 of 1739 patients during the follow-up period (45.6±9.1 months). The multivariate Cox regression analysis showed baseline eGFRs, ΔeGFR, and summed stress scores to be significant independent variables for prediction of cardiac death. The area under receiver operating characteristic curves for detection of cardiac death was 0.677 for the baseline eGFR and 0.802 for the follow-up eGFR. Sensitivity of detection of cardiac death was significantly higher in the follow-up eGFR than in the baseline eGFR (p=0.0002). Combination of the best cut-off values, i.e. 9 for the summed stress scores and 10 for the ΔeGFR, which were suggested by receiver operating characteristic analysis, was useful for risk stratification of cardiac death both in patients with and without chronic kidney disease. CONCLUSION Baseline and follow-up eGFRs as well as nuclear variables are useful to predict cardiac death in patients with known/suspected CAD.
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Affiliation(s)
- Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
| | - Kanae Nakanishi
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Ayako Tano
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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Usefulness of automated assessment of nuclear cardiology for prediction of major cardiac events in Japanese patients with known or suspected coronary artery disease: Comparison with conventional visual assessment in a large-scale prognostic study. J Cardiol 2014; 64:395-400. [DOI: 10.1016/j.jjcc.2014.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/05/2014] [Accepted: 02/21/2014] [Indexed: 11/23/2022]
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12
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Hori Y, Yoda S, Nakanishi K, Tano A, Suzuki Y, Matsumoto N, Hirayama A. Myocardial ischemic reduction evidenced by gated myocardial perfusion imaging after treatment results in good prognosis in patients with coronary artery disease. J Cardiol 2014; 65:278-84. [PMID: 25082293 DOI: 10.1016/j.jjcc.2014.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are no nuclear cardiology reports indicating the prediction of prognosis based on ischemic reduction after revascularization in Japanese patients with coronary artery disease (CAD). We aimed to evaluate quantitatively ischemia using myocardial perfusion single photon emission computed tomography (SPECT) before and after treatment such as revascularization and to determine a relationship between the ischemic reduction and the incidence of major cardiac events (MCEs) after the treatment in patients with CAD. METHODS We retrospectively investigated 513 patients who underwent rest (201)Tl and stress (99m)Tc-tetrofosmin myocardial perfusion SPECT between October 2004 and March 2011 and who had a significant stenosis with 75% or greater narrowing of the coronary arterial diameter detected by coronary angiography performed after confirmation of ≥5% ischemia with SPECT. The patients underwent the treatment including revascularization and medication and thereafter were re-evaluated with SPECT during a chronic phase and followed up to confirm prognosis for ≥1 year. The follow-up period was 33.4±16.4 months. The endpoint was the incidence of the MCEs consisting of cardiac death, non-fatal myocardial infarction, and unstable angina pectoris. RESULTS During the follow-up, 45 patients experienced MCEs comprising cardiac death (n=13), non-fatal myocardial infarction (n=3), and unstable angina pectoris (n=29). The multivariate Cox proportional hazards regression model analysis for the risk of the MCEs showed the changes in the summed difference score % (p=0.0102) and the stress left ventricular ejection fraction after the treatment (p=0.0146) as significant independent variables. The incidence of the MCEs significantly decreased in the patients with ≥5% ischemic reduction than in the patients without ≥5% ischemic reduction and in the patients without residual ischemia than in the patients with the residual ischemia. CONCLUSION Myocardial ischemic reduction detected by nuclear cardiology leads to a decrease in MCE rates after treatment in Japanese patients with CAD.
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Affiliation(s)
- Yusuke Hori
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Shunichi Yoda
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
| | - Kanae Nakanishi
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Ayako Tano
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
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Myocardial Perfusion Imaging for Risk Stratification in Asymptomatic Individuals Without Known Cardiovascular Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-013-9253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Nakajima K, Takeishi Y, Matsuo S, Yamasaki Y, Nishimura T. Metabolic syndrome is not a predictor for cardiovascular events in Japanese patients with diabetes mellitus asymptomatic for coronary artery disease: a retrospective analysis of the J-ACCESS-2 study. J Nucl Cardiol 2013; 20:234-41. [PMID: 23196975 DOI: 10.1007/s12350-012-9656-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 11/01/2012] [Indexed: 01/17/2023]
Abstract
PURPOSE Patients with metabolic syndrome (MetS) have potentially higher risk for cardiovascular events. The aim of this study was to evaluate the effect of MetS on cardiac events in type-2 diabetic patients asymptomatic for coronary artery disease (CAD) in a Japanese population. METHODS A total of 485 patients from a J-ACCESS-2 investigation with stress-gated myocardial perfusion imaging (MPI) and quantitative-gated MPI analysis were examined. Cardiovascular hard events (cardiac death and acute coronary syndrome) and total events during a 3-year follow-up were analyzed. RESULTS The MetS group (n = 229) had higher incidence of hypertension, dyslipidemia, and ventricular dilatation than the non-MetS group (n = 256). The hard events were 8 and 12 for the MetS and non-MetS groups (P = n.s.), and total events were 31 and 31 for each of these groups, respectively (P = n.s.). Significant variables related to total cardiovascular events included age, current smoking, insulin use, total cholesterol, ejection fraction, summed stress score ≥ 9, and summed difference score ≥ 2. Cox proportional hazard analysis and Kaplan-Meier survival analysis showed that only the summed stress score was related to total events (P = .01), and the presence and the number of items for MetS criteria were not. CONCLUSION In patients with type 2 diabetes asymptomatic for CAD, cardiovascular events and ischemia are as common in diabetic patients without MetS as in those with MetS. A high MPI defect score is related to total events including cardiac and cerebrovascular events.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
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15
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Bourque JM, Patel CA, Ali MM, Perez M, Watson DD, Beller GA. Prevalence and predictors of ischemia and outcomes in outpatients with diabetes mellitus referred for single-photon emission computed tomography myocardial perfusion imaging. Circ Cardiovasc Imaging 2013; 6:466-77. [PMID: 23547172 DOI: 10.1161/circimaging.112.000259] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background- The prevalence of ischemia and its prediction of events are unclear in outpatients with diabetes mellitus in the modern era of intensive medical management. We sought to identify the prevalence of ischemia, subsequent cardiac events, and impact of sex, stress type, and symptom status on these findings in a cohort of stable outpatients with diabetes mellitus referred for single-photon emission computed tomography myocardial perfusion imaging (MPI). Methods and Results- The study cohort included 575 consecutive outpatients with diabetes mellitus who underwent quantitative, gated single-photon emission computed tomography MPI. Clinical information, stress MPI variables, and cardiac events were prospectively collected and analyzed. The study population was at intermediate risk of coronary artery disease or had known coronary artery disease (40.3%); 29% of patients were asymptomatic at the time of stress testing. Scintigraphic ischemia and significant (≥10%) left ventricular ischemia were present in 126 patients (21.9%) and 29 patients (5.0%), respectively, and <1% of patients had early revascularization. The risk of ischemia was increased >2-fold by male sex (P<0.001), but was not impacted by pharmacological stress (P=0.15) or presence of symptoms (P=0.89). During a median 4.4 years follow-up, the rate of cardiac death/nonfatal myocardial infarction was moderate at 2.6%/y (cardiac death 0.8%/y) in the total cohort, but was 5.7%/y in those with ischemia (P<0.001). Pharmacological stress predicted a higher cardiac event rate (P<0.001) but symptoms did not (P=0.55). Conclusions- This cohort of stable outpatients with diabetes mellitus referred for single-photon emission computed tomography had low rates of significant ischemia and early revascularization; an initially low cardiac event rate increased after 2 years. Independent predictors of cardiac death/nonfatal myocardial infarction were known coronary artery disease, pharmacological stress, and MPI ischemia. Nearly one third of those with events had a normal MPI, indicating a need for improved risk stratification.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, Department of Radiology, University of Virginia Health System, Charlottesville, VA; and Cardiovascular Division, Department of Internal Medicine, Medical University of South Carolina, Charleston, SC
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Prognostic value of myocardial perfusion imaging for cardiovascular events among asymptomatic Japanese patients with type 2 diabetes and mild renal dysfunction. Nucl Med Commun 2013; 34:328-32. [PMID: 23376861 DOI: 10.1097/mnm.0b013e32835e89ab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Diabetes is frequently accompanied by chronic kidney disease, and both diabetes and chronic kidney disease are risk factors for ischemic heart disease; however, cardiac risk among diabetic patients with mild renal dysfunction has not been analyzed in detail. The present study investigates how myocardial perfusion imaging (MPI) contributes to the risk stratification of diabetic patients with mild renal dysfunction who are asymptomatic for cardiac diseases. PATIENTS AND METHODS Among 513 asymptomatic patients with type 2 diabetes in the Japanese Assessment of Cardiac Events and Survival Study 2 (J-ACCESS) database, we selected 286 with estimated glomerular filtration rates (eGFR) of at least 45 ml/min/1.73 m and assigned them to groups on the basis of eGFR of at least 60 without (group A, n=66) or with microalbuminuria or eGFR 45 to less than 60 (group B, n=220). The 3-year incidence of cardiac events and the value of MPI were evaluated. RESULTS Cardiac events developed in 1.52 and 4.55% of patients in groups A and B, respectively. Event-free survival did not differ according to summed stress scores in group A but was significantly lower among patients with summed stress scores of at least 9 in group B. CONCLUSION Routine MPI might be useful for stratifying risk among diabetic patients with mild renal dysfunction but is unnecessary for those with good renal function.
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Microalbuminuria predicts silent myocardial ischaemia in type 2 diabetes patients. Eur J Nucl Med Mol Imaging 2013; 40:548-57. [PMID: 23314258 DOI: 10.1007/s00259-012-2323-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 12/10/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE Myocardial ischaemia is frequently silent in patients with type 2 diabetes. Although it has been proposed as a potential screening tool, the role of myocardial perfusion single photon emission computed tomography (MPS) has recently been questioned, due to the low prevalence of positive scans and the low rate of cardiac events. The aim of this study was to assess if pretest clinical variables can identify a subgroup of asymptomatic patients with type 2 diabetes at risk of silent myocardial ischaemia and a subsequent poor outcome METHODS This prospective study included 77 patients (50 men, mean age 63 ± 9 years) with type 2 diabetes and no known coronary artery disease (CAD) or angina pectoris who underwent gated MPS to screen for CAD between March 2006 and October 2008. MPS images were interpreted using a semiquantitative visual 20-segment model to define summed stress, rest and difference scores. Ischaemia was defined as a sum difference score (SDS) ≥2. Patients were followed-up (median 4.1 years, range 0.8 - 6.1 years) and cardiac hard events (cardiac death or nonfatal myocardial infarction) were recorded. RESULTS Silent ischaemia was detected in 25 of the 77 patients (32 %). Specifically, 10 patients (13 %) had mild ischaemia (SDS 2 to ≤4) and 15 patients (19 %) had severe ischaemia (SDS >4). In univariate binary logistic analysis, microalbuminuria was the only significant predictor of silent ischaemia on MPS (odds ratio 4.42, 95 % CI 1.27 - 15.40; P = 0.019). The overall accuracy of microalbuminuria for predicting silent ischaemia was 71.4 % and was 89.6 % for predicting severe ischaemia. Kaplan-Meier curves showed no significant group differences in 5-year cardiac event-free survival between patients with and those without microalbuminuria, or between patients with SDS ≥2 and those with SDS <2. In contrast, 5-year event-free survival was significantly lower in patients with SDS >4 than in patients with SDS ≤4: 55.6 % (95 % CI 39.0 - 72.2 %) vs. 94.5 % (95 % CI: 91.4 - 97.6 %), respectively (Breslow test, chi-square 20.9, P < 0.001). Median cardiac event-free survival was not observed in the whole group, while the 25th percentile of cardiac event-free survival was reached only in patients with SDS >4 (2.3 years). In univariate Cox regression analysis, SDS >4 predicted cardiac event-free survival (hazard ratio 12.87, 95 % CI 2.86 - 27.98; P = 0.001), while SDS ≥2 did not (hazard ratio 2.78, 95 % CI 0.62 - 12.46, P = 0.16). CONCLUSION In this group of patients with type 2 diabetes, microalbuminuria was the only predictor of silent ischaemia on MPS. Assessment of microalbuminuria should be routinely considered among the first risk stratification steps for CAD in patients with type 2 diabetes, even though severe ischaemia on MPS is a major predictor of cardiac event-free survival.
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Yamasaki Y, Katakami N, Kaneto H, Nakajima K, Kusuoka H, Kashiwagi A, Nishimura T. Improved lipid profiles are associated with reduced incidence of coronary vascular events in asymptomatic patients with type 2 diabetes and impaired myocardial perfusion. J Atheroscler Thromb 2012; 20:330-5. [PMID: 23258080 DOI: 10.5551/jat.13474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Individuals with type 2 diabetes are at high risk for cardiovascular events; however, a modality that could reduce risk has not been fully evaluated. We examined the annual incidence rate of cardiovascular events in asymptomatic Japanese diabetic patients who underwent gated myocardial perfusion single-photon computed tomography (SPECT). METHODS Asymptomatic patients (n= 485) aged ≥50 years and with either a maximal carotid artery intima-media thickness of ≥1.1 mm, or urinary albumin ≥30 mg/g creatinine, or at least two of abdominal obesity, low HDL cholesterol, high triglyceride levels and hypertension were evaluated at 50 institutions using gated SPECT with the stress-rest protocol and were followed up for three years. In the patients with summed stress scores (SSS) of ≥9, the initial high cardiovascular incidence rate in the first year declined significantly (p<0.001) from 21% to 2% during the second and third year. RESULTS The incident rate was consistent among diabetics with low SSS during follow-up. Baseline LDL and non-HDL cholesterol levels significantly reduced (123±6.4 to 99±6.1 mg/dL; p<0.05) during the first year in diabetic patients with high SSS, but did not significantly change in diabetic patients with low (<9) SSS. CONCLUSION The immediate improvement of lipid levels within one year correlated with the significant reduction in CVD events arising in diabetic patients with moderate or severe myocardial ischemia. Thus, rapidly lowering hyperlipidemia is very effective for patients with type 2 diabetes at high risk for cardiac events.
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Nakajima K, Matsuo S, Okuyama C, Hatta T, Tsukamoto K, Nishimura S, Yamashina A, Kusuoka H, Nishimura T. Cardiac event risk in Japanese subjects estimated using gated myocardial perfusion imaging, in conjunction with diabetes mellitus and chronic kidney disease. Circ J 2011; 76:168-75. [PMID: 22104035 DOI: 10.1253/circj.cj-11-0857] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac event risk is estimated using quantitative gated myocardial perfusion imaging (MPI) and clinical background in patients with ischemic heart disease. The aim of the present study was to calculate major cardiac event risk and tabulate it in the Heart Risk Table for clinical use of risk stratification. METHODS AND RESULTS Multivariate logistic regression was performed based on a multicenter prognostic database (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated Single-photon emission computed tomography [J-ACCESS investigation]) using MPI (n=2,395). The risk of major cardiac events (cardiac death, non-fatal myocardial infarction and heart failure requiring hospitalization) was estimated using age, ejection fraction (EF), estimated glomerular filtration rate (eGFR) and presence of diabetes mellitus (DM). Age-matched standard eGFR was determined in 77 subjects. Major cardiac event risk was calculated using the equation: risk (%/3 years)=1/(1+Exp(-(-4.699-0.0151×eGFR+0.7998×DM+0.0582×age+0.697×SSS-0.0359×EF))×100, where SSS refers to summed stress scores. Risk was determined without eGFR (the initial version) and using the present formula with eGFR (revised version), with consistent results. DM and chronic kidney disease were major determinants of cardiac events. CONCLUSIONS Cardiac event risk was estimated using MPI defect score and left ventricular EF in conjunction with eGFR and the presence of DM. The risk table might be used for risk evaluation in Japanese patients undergoing MPI.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
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Igarashi Y, Chikamori T, Hida S, Tanaka H, Shiba C, Usui Y, Hatano T, Yamashina A. Importance of the ankle-brachial pressure index in the diagnosis of coronary artery disease in women with diabetes without anginal pain. Circ J 2011; 75:2206-12. [PMID: 21757821 DOI: 10.1253/circj.cj-10-1287] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinical symptoms of coronary artery disease (CAD) are often atypical in women, particularly in those with diabetes mellitus. Therefore, a simple diagnostic test to identify a high-risk subset of women with diabetes who are likely to have CAD is important. METHODS AND RESULTS A total of 407 consecutive patients (319 men and 88 women, age range 68 ± 11 years) with suspected CAD, who were not complaining of anginal pain, were evaluated. Among these patients, 170 had diabetes. Stress myocardial perfusion imaging and simultaneous brachial and ankle blood pressure measurements were performed to obtain the ischemic total perfusion deficit (TPD) and ankle-brachial pressure index (ABI), respectively. Ischemic TPD was not significantly different between men and women, whereas ischemic TPD was significantly greater in diabetic patients than in non-diabetic patients (6.9 ± 7.7% vs. 4.9 ± 6.1%; P = 0.005). In diabetic patients, ischemic TPD was not significantly different between men and women. However, women with ABI<0.9 showed significantly greater ischemic TPD than those with ABI≥0.9 (12.1 ± 10.8% vs. 5.1 ± 5.9%; P=0.04), whereas no difference in ABI was observed in men. CONCLUSIONS ABI was useful in evaluating CAD in asymptomatic women with diabetes to detect a high-risk subset showing the ischemic TPD of >10%, which is regarded as a scintigraphic indicator for coronary revascularization.
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Affiliation(s)
- Yuko Igarashi
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
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21
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Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK, Smith SC, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Nishimura R, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 56:e50-103. [PMID: 21144964 DOI: 10.1016/j.jacc.2010.09.001] [Citation(s) in RCA: 1001] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kato M, Matsumoto N, Nakano Y, Suzuki Y, Yoda S, Sato Y, Kasama S, Nagao K, Hirayama A. Combined assessment of myocardial perfusion and function by ECG-gated myocardial perfusion single-photon emission computed tomography for the prediction of future cardiac events in patients with type 2 diabetes mellitus. Circ J 2010; 75:376-82. [PMID: 21178295 DOI: 10.1253/circj.cj-10-0794] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The mid-term prognostic significance of ECG-gated single-photon emission computed tomography (SPECT) remains unclear in Japanese patients with type 2 diabetes mellitus (DM). In the present study rates of future cardiac events (nonfatal acute myocardial infarction (AMI), cardiac death (CD) and severe heart failure (HF) requiring hospitalization) were compared in patients with and without DM. METHODS AND RESULTS 1,810 patients (563 DM and 1,247 non-DM) we followed for a mean of 26.3±15.5 months. Summed stress score (SSS), summed difference score (SDS), poststress ejection fraction (EF) and resting end-diastolic volume (EDV) were calculated. In total, 20 cases of AMI (9 in DM (1.59%) and 11 in non-DM (0.88%)), 20 of CD (7 in DM patients (1.24%) and 13 in non-DM (1.04%)) and 54 of severe HF (31 in DM (5.5%) and 23 in non-DM (1.84%)) occurred. Univariate Cox analysis showed that, in DM patients, predictors of total cardiac events were poststress EF (Wald 60.4; P<0.001), resting EDV (Wald 53.8; P<0.001), SSS (Wald 39.6; P<0.001), SDS (Wald 26.1; P<0.001), history of prior MI (Wald 4.32; P<0.05) and hemoglobin A(1c) value (Wald 4.30; P<0.05). Multivariate Cox analysis showed that poststress EF (Wald 9.85; P<0.01) and SDS (Wald 6.19; P<0.01) were independent predictors of total cardiac events. CONCLUSIONS Combined assessment of perfusion and function by ECG-gated SPECT may predict future cardiac events in type 2 DM patients.
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Affiliation(s)
- Masahiko Kato
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2010; 122:e584-636. [PMID: 21098428 DOI: 10.1161/cir.0b013e3182051b4c] [Citation(s) in RCA: 402] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yamasaki Y, Nakajima K, Kusuoka H, Izumi T, Kashiwagi A, Kawamori R, Shimamoto K, Yamada N, Nishimura T. Prognostic value of gated myocardial perfusion imaging for asymptomatic patients with type 2 diabetes: the J-ACCESS 2 investigation. Diabetes Care 2010; 33:2320-6. [PMID: 20724653 PMCID: PMC2963487 DOI: 10.2337/dc09-2370] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Individuals with type 2 diabetes are at high risk for cardiovascular events. We evaluated the prognostic value of gated myocardial perfusion single-photon computed tomography (SPECT) for asymptomatic diabetic patients in a Japanese population. RESEARCH DESIGN AND METHODS Asymptomatic patients (n=485) aged≥50 years with either a maximal carotid artery intima-media thickness of ≥1.1 mm, or a urinary albumin ≥30 mg/g creatinine or who had at least two of the following, abdominal obesity, low HDL cholesterol, high triglyceride levels, and hypertension, were enrolled at 50 institutions. The patients were evaluated using gated SPECT with the stress-rest protocol and followed up for 3 years. RESULTS During the follow-up period, 62 (13%) events occurred, including 5 cardiac deaths and 57 cardiovascular events. Patients with summed stress scores (SSS) of ≥9 had a significantly higher incidence (of either death or cardiovascular events) than those with SSS scores of <9 (23 vs. 12%; P=0.009). Multivariate Cox regression analysis showed that significant variables were SSS≥9, a low estimated glomerular filtration rate, and being a current smoker. Univariate Cox regression analysis showed that ticlopidine and insulin use are potent medical modulators of cardiovascular events. CONCLUSIONS The incidences of cardiovascular events and death were significantly high in a select population of type 2 diabetic patients with SPECT abnormalities. A targeted treatment strategy is required for asymptomatic but potentially high-risk patients with type 2 diabetes.
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Matsuo S, Nakajima K, Kinuya S. Clinical use of nuclear cardiology in the assessment of heart failure. World J Cardiol 2010; 2:344-56. [PMID: 21160612 PMCID: PMC2999043 DOI: 10.4330/wjc.v2.i10.344] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 09/01/2010] [Accepted: 09/08/2010] [Indexed: 02/06/2023] Open
Abstract
A nuclear cardiology test is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays a pivotal role in their assessment and management. Quantitative gated single positron emission computed tomography (QGS) is used to assess quantitatively cardiac volume, left ventricular ejection fraction (LVEF), stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging, with exercise or pharmacologic stress, plays a fundamental role in distinguishing ischemic from non-ischemic etiology of heart failure, and in demonstrating myocardial viability. Diastolic heart failure also termed as heart failure with a preserved LVEF is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate (PFR) and time to PFR. Movement of the left ventricle can also be readily assessed by QGS, with newer techniques such as three-dimensional, wall thickening evaluation aiding its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using (123)I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using (123)I-15-(p-iodophenyl)3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to refine heart failure diagnosis. Nuclear cardiology studies contribute significantly to guiding management decisions for identifying cardiac risk in patients with heart failure.
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Affiliation(s)
- Shinro Matsuo
- Shinro Matsuo, Kenichi Nakajima, Seigo Kinuya, Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
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Matsuo S, Nakajima K, Yamasaki Y, Kashiwagi A, Nishimura T. Prognostic Value of Normal Stress Myocardial Perfusion Imaging and Ventricular Function in Japanese Asymptomatic Patients With Type 2 Diabetes - A Study Based on the J-ACCESS-2 Database -. Circ J 2010; 74:1916-21. [DOI: 10.1253/circj.cj-10-0098] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital
| | | | | | | | - Tsunehiko Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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