Value of peripheral vascular endothelial function in the detection of relative myocardial ischemia in asymptomatic type 2 diabetic patients who underwent myocardial perfusion imaging

Georgios I. Papaioannou, Christos Kasapis, Richard L. Seip, Neil J. Grey, Deborah Katten, Frans J.Th Wackers, Silvio E. Inzucchi, Samuel Engel, Amy Taylor, Lawrence H. Young, Deborah A. Chyun, Janice A. Davey, Ami E. Iskandrian, Robert E. Ratner, Evelyn C. Robinson, Stella Carolan, Gary V. Heller

Research output: Contribution to journalArticle

Abstract

Background: Endothelial dysfunction precedes overt atherosclerosis and is present in patients with type 2 diabetes mellitus (T2DM). Myocardial perfusion imaging (MPI) is an effective method of detection of coronary artery disease (CAD); however, the relationship between endothelial function and MPI in asymptomatic patients with T2DM has not been examined. Methods and Results: This study used a subset of the population from the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study. Endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIV) were measured by use of brachial artery ultrasonography in 75 asymptomatic patients with T2DM (56 men; mean age, 58.6 ± 6.4 years; mean duration of diabetes, 8.4 ± 7.5 years) who underwent adenosine MPI. Of the patients, 15 (20%) had evidence of relative ischemia (MPI+) whereas 60 (80%) had a normal study (MPI-). Both EDV (3.5% ± 3.7% vs 4.5% ± 6.6%, P = not significant) and EIV (15.1% ± 7.5% vs 16.8% ± 8.4%, P = not significant) were similar in the 2 groups. On the basis of a receiver-operator analysis, an EDV response of 8% was selected as a cut point, with a negative predictive value of 93% (13/14 subjects with EDV ≥8% were MPI-). Conclusions: Endothelial function in asymptomatic patients with T2DM is not associated with the presence of relative myocardial ischemia by MPI; however, an EDV of 8% or greater has a high negative predictive value for the exclusion of CAD.

Original languageEnglish (US)
Pages (from-to)362-368
Number of pages7
JournalJournal of Nuclear Cardiology
Volume13
Issue number3
DOIs
StatePublished - Jun 2006

Keywords

  • Endothelial function
  • myocardial perfusion imaging
  • type 2 diabetes mellitus

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Papaioannou, G. I., Kasapis, C., Seip, R. L., Grey, N. J., Katten, D., Wackers, F. J. T., Inzucchi, S. E., Engel, S., Taylor, A., Young, L. H., Chyun, D. A., Davey, J. A., Iskandrian, A. E., Ratner, R. E., Robinson, E. C., Carolan, S., & Heller, G. V. (2006). Value of peripheral vascular endothelial function in the detection of relative myocardial ischemia in asymptomatic type 2 diabetic patients who underwent myocardial perfusion imaging. Journal of Nuclear Cardiology, 13(3), 362-368. https://doi.org/10.1016/j.nuclcard.2006.01.022