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Associations of cardiovascular and diabetes-related risk factors with myocardial perfusion reserve assessed by 201Tl/99mTc-tetrofosmin single-photon emission computed tomography in patients with diabetes mellitus and stable coronary artery disease

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Abstract

We aimed to examine the associations of cardiovascular risk factors with myocardial perfusion reserve (MPR) in patients with type 2 diabetes and stable coronary artery disease. The study patients were retrospectively identified from a database of patients with diabetes and stable coronary artery disease at Asan Medical Center (Seoul, Republic of Korea), covering the period from 2017 to 2019. The primary outcome variable was MPR assessed by dynamic stress 201Tl/rest 99mTc-tetrofosmin SPECT. Univariable and stepwise multivariable analyses were performed to assess the associations of cardiovascular risk factors with MPR. A total of 276 patients (236 men and 40 women) were included. The median global MPR was 2.4 (interquartile range 1.9–3.0). Seventy-five (27.2%) patients had an MPR < 2.0. Multivariable linear regression showed that smoking (ß = − 0.44, 95% confidence interval − 0.68 to − 0.21, P < 0.001), hypertension (ß = − 0.24, 95% confidence interval − 0.47 to − 0.02, P = 0.033), and summed difference score (ß = − 0.05, 95% confidence interval − 0.07 to − 0.03, P < 0.001) were independently associated with MPR. Abnormal MPR (< 2.0) was associated with a higher incidence of cardiac death or myocardial infarction (P = 0.034). MPR assessed by dynamic stress 201Tl/rest 99mTc-tetrofosmin SPECT was impaired in a large cohort of patients with diabetes. After adjusting for risk variables, including standard myocardial perfusion imaging characteristics, smoking, and hypertension were associated with MPR. Our results may aid in identifying patients with impaired MPR and stratifying patients with type 2 diabetes.

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Funding

This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number HR18C0016).

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Author notes

  1. Dr. Joon Ho Choi and Dr. Sangwon Han contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea

    Joon Ho Choi

  2. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Sangwon Han, Eonwoo Shin, Minyoung Oh & Dae Hyuk Moon

  3. Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea

    Ji Eun Moon

  4. Department of Nuclear Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea

    Sun Young Chae

  5. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Cheol Whan Lee

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Contributions

Material preparation and data collection were performed by J.H.C, E.S., M.O., S.Y.C., C.W.L., and D.H.M. Data analysis were performed by J.H.C., S.H., J.E.M.M, and D.H.M. Conception and interpretation of data were performed by J.H.C., S.H., and D.H.M. The first draft of the manuscript was written by Dae Hyuk Moon, and all authors commented on early versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dae Hyuk Moon.

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Conflict of interest

D.H.M. has received research grants from GE Healthcare. For the remaining authors none were declared.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki and was approved by the institutional review board of Asan Medical Center (2019 − 1391).

Consent to participate

The institutional review board of Asan Medical Center (2019 − 1391) waived the need for informed consent.

Consent for publication

The institutional review board of Asan Medical Center (2019 − 1391) approved publication of the study results to the research community.

Competing interests

Dae Hyuk Moon has received research grants from GE Healthcare. For the remaining authors none were declared.

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Choi, J.H., Han, S., Shin, E. et al. Associations of cardiovascular and diabetes-related risk factors with myocardial perfusion reserve assessed by 201Tl/99mTc-tetrofosmin single-photon emission computed tomography in patients with diabetes mellitus and stable coronary artery disease. Int J Cardiovasc Imaging 39, 1605–1613 (2023). https://doi.org/10.1007/s10554-023-02859-1

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