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Ahmad A, Lim LL, Morieri ML, Tam CHT, Cheng F, Chikowore T, Dudenhöffer-Pfeifer M, Fitipaldi H, Huang C, Kanbour S, Sarkar S, Koivula RW, Motala AA, Tye SC, Yu G, Zhang Y, Provenzano M, Sherifali D, de Souza RJ, Tobias DK, Gomez MF, Ma RCW, Mathioudakis N. Precision prognostics for cardiovascular disease in Type 2 diabetes: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2024; 4:11. [PMID: 38253823 PMCID: PMC10803333 DOI: 10.1038/s43856-023-00429-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: 05/12/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with Type 2 diabetes (T2D). METHODS We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies. RESULTS Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort. CONCLUSIONS Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
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Affiliation(s)
- Abrar Ahmad
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Asia Diabetes Foundation, Hong Kong SAR, China
| | - Mario Luca Morieri
- Metabolic Disease Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Claudia Ha-Ting Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Feifei Cheng
- Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hugo Fitipaldi
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Chuiguo Huang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Sudipa Sarkar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Wilhelm Koivula
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sok Cin Tye
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
- Sections on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gechang Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yingchai Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michele Provenzano
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Diana Sherifali
- Heather M. Arthur Population Health Research Institute, McMaster University, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | | | - Maria F Gomez
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden.
- Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Nestoras Mathioudakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Megna R, Petretta M, Nappi C, Assante R, Zampella E, Gaudieri V, Mannarino T, D’Antonio A, Green R, Cantoni V, Panico M, Acampa W, Cuocolo A. Age-Specific Cardiovascular Risk Factors for Major Adverse Cardiac Events in Patients Undergoing Myocardial Perfusion Imaging. J Cardiovasc Dev Dis 2023; 10:395. [PMID: 37754824 PMCID: PMC10531606 DOI: 10.3390/jcdd10090395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The prevalence of traditional cardiovascular risk factors shows different age-specific patterns. It is not known whether the prognostic impact of risk factors is similarly age-specific. We evaluated the profiles of cardiovascular risk factors and their prognostic impact on coronary artery disease (CAD) in relation to age. METHODS We included 3667 patients with suspected or known CAD undergoing stress myocardial perfusion imaging (MPI). We evaluated the risk for major adverse cardiac events (MACE) within three years from the index MPI in patients belonging to three groups according to age tertile distribution: <59, 59-68, and >68 years. Gender, body mass index, diabetes, hypertension, dyslipidemia, family history of CAD, smoking, angina, dyspnea, previous CAD, and MPI outcome were assessed as risk factors by a multivariable Cox's regression. RESULTS The three-year risk of MACE increased progressively with age and was 9%, 13%, and 18% for each group, respectively (p < 0.0001). Dyspnea and abnormal MPI outcome were significant risk factors for all age groups. Diabetes and smoking were significant from the age of 59 onwards, while hypertension resulted significant for patients older than 68 years. CONCLUSIONS The number of risk factors was significantly associated with the occurrence of MACE increase with age. It is noteworthy that a personal history of CAD was not useful for risk stratification, while MPI results were.
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Affiliation(s)
- Rosario Megna
- Institute of Biostructure and Bioimaging, National Council of Research, via T. De Amicis 95, 80145 Naples, Italy;
| | - Mario Petretta
- IRCCS Synlab SDN, via Gianturco 113, 80143 Naples, Italy;
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Adriana D’Antonio
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, via T. De Amicis 95, 80145 Naples, Italy;
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
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Ahmad A, Lim LL, Morieri ML, Tam CHT, Cheng F, Chikowore T, Dudenhöffer-Pfeifer M, Fitipaldi H, Huang C, Kanbour S, Sarkar S, Koivula RW, Motala AA, Tye SC, Yu G, Zhang Y, Provenzano M, Sherifali D, de Souza R, Tobias DK, Gomez MF, Ma RCW, Mathioudakis NN. Precision Prognostics for Cardiovascular Disease in Type 2 Diabetes: A Systematic Review and Meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.26.23289177. [PMID: 37162891 PMCID: PMC10168509 DOI: 10.1101/2023.04.26.23289177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with type 2 diabetes (T2D). Methods We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies. Results Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort. Conclusions Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
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Zotou P, Bechlioulis A, Tsiouris S, Naka KK, Xourgia X, Pappas K, Lakkas L, Rammos A, Kalef-Ezra J, Michalis LK, Fotopoulos A. The Role of Myocardial Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events at 1 Year Follow-Up: A Single Center's Experience. J Pers Med 2023; 13:jpm13050871. [PMID: 37241041 DOI: 10.3390/jpm13050871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Myocardial perfusion imaging via single-photon emission computed tomography (SPECT MPI) is a well-established method of diagnosing coronary artery disease (CAD). The purpose of this study was to assess the role of SPECT MPI in predicting major cardiovascular events. METHODS The study population was composed of 614 consecutive patients (mean age: 67 years, 55% male) referred for SPECT MPI due to symptoms of stable CAD. The SPECT MPI was performed using a single-day protocol. We conducted a follow-up on all patients at 12 months via a telephone interview. RESULTS The majority of our patients (78%) presented findings suggestive of reversible ischemia, fixed defects or both. Extensive perfusion defects were found in 18% of the population, while LV dilation was found in 7%. During the 12-month follow-up, 16 deaths, 8 non-fatal MIs and 20 non-fatal strokes were recorded. There was no significant association of SPECT findings with the combined endpoint of all-cause death, non-fatal MI and non-fatal stroke. The presence of extensive perfusion defects was an independent predictor of mortality at 12 months (HR: 2.90, 95% CI: 1.05, 8.06, p = 0.041). CONCLUSIONS In a high-risk patient population with suspected stable CAD, only large reversible perfusion defects in SPECT MPI were independently associated with mortality at 1 year. Further trials are needed to validate our findings and refine the role of SPECT MPI findings in the diagnosis and prognosis of cardiovascular patients.
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Affiliation(s)
- Paraskevi Zotou
- Nuclear Medicine Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Aris Bechlioulis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Spyridon Tsiouris
- Nuclear Medicine Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Katerina K Naka
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Xanthi Xourgia
- Nuclear Medicine Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Konstantinos Pappas
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Lampros Lakkas
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Aidonis Rammos
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45500 Ioannina, Greece
| | - John Kalef-Ezra
- Nuclear Medicine Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Andreas Fotopoulos
- Nuclear Medicine Department, University Hospital of Ioannina, 45500 Ioannina, Greece
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Zhao X, Jin F, Wang J, Zhao X, Wang L, Wei H. Entropy of left ventricular late gadolinium enhancement and its prognostic value in hypertrophic cardiomyopathy a new CMR assessment method. Int J Cardiol 2023; 373:134-141. [PMID: 36395920 DOI: 10.1016/j.ijcard.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE As a novel metric, entropy generated from late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) can be utilized to assess tissue heterogeneity. However, it is unknown if it can be utilized for risk stratification in hypertrophic cardiomyopathy (HCM). In addition, it is unknown if LGE entropy correlates with LGE mass%, which is commonly utilized for fibrosis assessment. This research was done to investigate these issues. MATERIALS AND METHODS Patients with HCM who underwent 3.0-T CMR between January 2015 and January 2020 were prospectively enrolled and classified into low- and high-risk groups according to the AHA/ACC risk stratification guideline for 2020. The LGE entropy was automatically estimated using a generic Python package algorithm. On CMR imaging, the LGE mass% was determined using the CVI 42 software. Endpoint events included sudden cardiac death (SCD), hospital readmission owing to heart failure, and implantable cardioverter defibrillator (ICD) treatment for ventricular arrhythmias. RESULTS A total of 109 HCM participants (70 males) were included. During the follow-up (23 ± 7 months), the patients in the high-risk group had higher LGE entropy (p < 0.001) and LGE mass% (p < 0.001) than those in the low-risk group, and patients with endpoint events had higher LGE entropy (p < 0.001) and LGE mass% (p < 0.001) than those without endpoint events. In all participants, there was a link between LGE entropy and LGE mass%, according to the Spearman rank correlation analysis (p < 0.001; r = 0.667). In ROC analysis, the area under the curve (AUC) of LGE entropy was 0.893 (95% CI, 0.794-0.993; P<0.001), AUC of LGE mass% was 0.826 (95% CI, 0.737-0.914; P<0.001), AUC of LVEF was 0.610 (95% CI, 0.473-0.748; P = 0.117) and AUC of 2020 AHA/ACC guideline for risk stratification was 0.716 (95% CI, 0.617-0.815; P = 0.002). According to Kaplan-Meier curves, HCM with a higher LGE entropy (≥cutoff value (<5.873) or ≥ thied tertile (5.540)) were more likely to experience the endpoint events. Following adjustment for the 2020 AHA/ACC guideline for risk categorization, LGE mass%, or decreased LVEF, Cox analysis showed that LGE entropy was independently linked with endpoint events. CONCLUSIONS The variability and extent of LGE pictures can be reflected by LGE entropy, which is a reliable, usable, and repeatable metric for risk classification in HCM. It is a prognostic indicator of endpoint events that is independent of other risk indicators.
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Affiliation(s)
- Xiaoying Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Dianmiandadao No. 374, Kunming, Yunnan 650000, China
| | - Fuwei Jin
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Dianmiandadao No. 374, Kunming, Yunnan 650000, China
| | - Jin Wang
- Department of Radiology, Yanan Hospital of Kunming City, Renmin Dong Lu No. 245, Kunming, Yunnan 650000, China.
| | - Xinxiang Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Dianmiandadao No. 374, Kunming, Yunnan 650000, China.
| | - Lujing Wang
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Dianmiandadao No. 374, Kunming, Yunnan 650000, China
| | - Hua Wei
- Department of Information, The Second Affiliated Hospital of Kunming Medical University，Dianmiandadao No. 374, Kunming, Yunnan 650000, China
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Alnabelsi T, Ahmed AI, Han Y, Al Rifai M, Nabi F, Cainzos-Achirica M, Al-Mallah MH. Added Prognostic Value of Plaque Burden to Computed Tomography Angiography and Myocardial Perfusion Imaging in Patients with Diabetes. Am J Med 2022; 135:761-768.e7. [PMID: 35081387 DOI: 10.1016/j.amjmed.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to compare the added prognostic value of plaque burden to cardiac computed tomographic angiography (CCTA) anatomic assessment and single-photon emission computed tomography (SPECT) physiologic assessment in patients with diabetes undergoing both tests. METHODS Consecutive patients with diabetes who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected coronary artery disease were included. Stenosis severity and segment involvement score (SIS) were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed from date of imaging for major adverse cardiovascular events (MACE). RESULTS A total of 778 patients were included (mean age 60.6 ± 14.4 years, 55% males). After a median follow-up of 31 months, 87 (11%) patients experienced a MACE. In multivariable Cox regression models, SIS significantly predicted outcomes in models including obstructive stenosis and ischemia (hazard ratio 1.17, 95% confidence interval 1.10-1.24, P < .001; hazard ratio 1.16, 95% confidence interval 1.10-1.23, P < .001, respectively), and improved discrimination (Harrel's C 0.75, P = .006; 0.76, P = .006 in models with CCTA obstructive stenosis and SPECT ischemia, respectively). Results were consistent using subgroups of summed scores by composition of plaque (calcified vs noncalcified) and alternate definitions of obstructive stenosis. CONCLUSION Our results suggest that in high-risk patients with diabetes and suspected coronary disease, SIS has incremental prognostic value over ischemia by SPECT or stenosis by CCTA in predicting incident cardiovascular outcomes.
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Affiliation(s)
| | | | - Yushui Han
- Houston Methodist Debakey Heart & Vascular Center, Houston, Tex
| | | | - Faisal Nabi
- Houston Methodist Debakey Heart & Vascular Center, Houston, Tex
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Nieves RA, Bukhari S, Harinstein ME. Adding value to myocardial perfusion scintigraphy: A prediction tool to predict adverse cardiac outcomes and risk stratify. J Nucl Cardiol 2021; 28:2283-2285. [PMID: 34169472 DOI: 10.1007/s12350-021-02670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ricardo A Nieves
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, 3E52.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Syed Bukhari
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, 3E52.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, 3E52.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Carabelli A, Canu M, de Fondaumière M, Debiossat M, Leenhardt J, Broisat A, Ghezzi C, Vanzetto G, Fagret D, Barone-Rochette G, Riou LM. Noninvasive assessment of coronary microvascular dysfunction using SPECT myocardial perfusion imaging and myocardial perfusion entropy quantification in a rodent model of type 2 diabetes. Eur J Nucl Med Mol Imaging 2021; 49:809-820. [PMID: 34417856 DOI: 10.1007/s00259-021-05511-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Coronary microvascular dysfunction (CMVD) plays a major role in the occurrence of cardiovascular events (CVE). We recently suggested the clinical potential of myocardial perfusion entropy (MPE) quantification from SPECT myocardial perfusion images (MPI) for the prognosis of CVE occurrence. We hypothesized that the quantification of MPE from SPECT MPI would allow the assessment of CMVD-related MPE variations in a preclinical model of type 2 diabetes (T2D) including treatment with the anti-diabetic incretin liraglutide (LIR). METHODS Optimal conditions for the preclinical quantification of MPE using 201Tl SPECT MPI were determined in rats with a T2D-like condition induced by a high-fat diet and streptozotocin injection (feasibility study, n = 43). Using such conditions, echocardiography and post-mortem LV capillary density evaluation were then used in order to assess the effect of LIR and the ability of MPE to assess CMVD (therapeutic study, n = 39). RESULTS The feasibility study identified dobutamine stress and acute NO synthase and cyclooxygenase inhibition as optimal conditions for the quantification of MPE, with significant increases in MPE being observed in T2D animals (P < 0.01 vs controls). In the therapeutic study, T2D rats were hyperglycemic (5.5 ± 0.5 vs 1.1 ± 0.3 g/L for controls, P < 0.001) and had a significantly lower left ventricular ejection fraction (LVEF) (65 ± 4% vs 74 ± 9%, P < 0.01) and LV capillary density (2400 ± 300 vs 2800 ± 600 mm-3, P < 0.05). LIR partially restored glycemia (3.9 ± 0.6 g/L, P < 0.05 vs controls and T2D), totally prevented LVEF impairment (72 ± 7%, P = NS vs CTL), with no significant effect on capillary density. MPE was significantly increased in T2D rats (7.6 ± 0.5 vs 7.1 ± 0.5, P < 0.05), with no significant improvement in T2D-LIR rats (7.4 ± 0.4, P = NS vs controls and T2D). CONCLUSION MPE quantification allowed the preclinical noninvasive assessment of CMVD. Both MPE and capillary density quantification suggested that LIR did not improve T2D-induced CMVD. The relevance of MPE for CMVD assessment warrants further clinical investigation.
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Affiliation(s)
- Adrien Carabelli
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000, Grenoble, France.,UMR UGA-INSERM U1039 Radiopharmaceutiques Biocliniques, Faculté de Médecine La Tronche, Isere, France
| | - Marjorie Canu
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000, Grenoble, France
| | | | | | - Julien Leenhardt
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000, Grenoble, France
| | - Alexis Broisat
- Univ. Grenoble Alpes, INSERM, LRB, 38000, Grenoble, France
| | | | - Gérald Vanzetto
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000, Grenoble, France
| | - Daniel Fagret
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000, Grenoble, France
| | | | - Laurent M Riou
- UMR UGA-INSERM U1039 Radiopharmaceutiques Biocliniques, Faculté de Médecine La Tronche, Isere, France. .,Univ. Grenoble Alpes, INSERM, LRB, 38000, Grenoble, France.
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