Review Article
Myocardial perfusion imaging for diabetes: Key points from the evidence and clinical questions to be answered

https://doi.org/10.1007/s12350-019-01846-1Get rights and content

Abstract

Diabetes represents a worldwide increasing problem and cardiovascular disease is the most common cause of death in diabetic patients. Pathophysiology that links diabetes to cardiovascular disease is a complex and multifactorial phenomenon evolving over time and involving both large blood vessels (macrovasculature) and small blood vessels (microvasculature). Myocardial perfusion imaging (MPI) imaging by both single-photon emission computer tomography and positron emission tomography with different specific tracers has become an indispensable tool for discriminating normal from diseased myocardial tissues and left ventricular function and monitoring myocardial blood flows, leading to the evaluation of almost overall physiologic consequences of the macro- and microvascular impairment involved in diabetic patients. This review will provide an overview of the role of MPI in the diagnosis and risk assessment of patients with diabetes and suspected or known CAD.

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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