Review ArticleMyocardial perfusion imaging for diabetes: Key points from the evidence and clinical questions to be answered
Section snippets
Diabetes and Cardiovascular Disease
Diabetes is a huge and growing problem and the costs to society are high and escalating. The worldwide prevalence of diabetes is expected to rise almost 592 million by the year 2035. The number of people with diabetes will increase by 55% by 2035.1,2 Cardiovascular disease (CVD) is the most common cause of death among people with diabetes. Pathophysiology that links diabetes to CVD is a complex and multifactorial phenomenon evolving over time and involving both large blood vessels
Macrovasculature
Atherosclerosis is the major threat to the macrovasculature for patients with and without diabetes. Evidences from a population-based autopsy study4 suggest that among diabetic subjects without clinical coronary artery disease (CAD), almost three-fourths have high-grade coronary atherosclerosis, and more than half had multivessel CAD. Noteworthy, diabetic decedents without clinical CAD had a global coronary disease burden and a prevalence of high-grade atherosclerosis similar to that observed
Myocardial Perfusion Imaging
Over the last decades, different strategies and approaches have been used to improve new imaging techniques in nuclear cardiology, enabling the detection of diseases at their earliest stages and the acquisition of high-resolution images to guide treatment process. In particular, tomographic imaging, by both single-photon emission computer tomography (SPECT) and positron emission tomography (PET) with different specific tracers, has become an indispensable tool for discriminating normal from
Clinical Question to be Answered in Agreement with Guidelines
Finding a robust non-invasive imaging technique to screen asymptomatic diabetic patients has been a focus of research, and the potential role of stress MPI has led to controversy and debates. The potential of newer non-invasive CAD screening methods to identify patient subgroups that may benefit from different treatment strategies remains unproven in asymptomatic diabetic patients, though research is ongoing. Although in asymptomatic diabetic patients a high coronary disease burden is linked to
Conclusion and Future Directions
Among different imaging modalities, MPI has been demonstrated to be a potent risk stratifier in patients with suspected or known CAD. The evaluation of CVD in diabetic patients is different compared to the non-diabetic counterpart and MPI has demonstrated to be able to make clear these differences in all the stages of cardiovascular structural and functional alterations. However, according to unsustainable rising cost of healthcare, the use of medical tests must be of proven clinical value.41
Disclosure
Acampa, Assante, Zampella, Petretta, and Cuocolo declare that they have no conflict of interest to disclose.
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All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Saurabh Malhotra, MD, MPH.
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