Nosheen Fatima, Sidra Zaman, Areeba Zaman, Anamta Zaman, Unaiza Zaman, Maseeh uz Zaman


Purpose: This prospective study was carried out to find negative predictive value (NPV) of normal myocardial perfusion imaging (MPI) in diabetic patients with predefined cut-off value of glycosylated hemoglobin A1c (HbA1c) ≤7.3%.  Methodology: This study was conducted at Karachi Institute of Heart Disease (KIHD) after prior approval from ethical committee. Total 257 diabetic patients who were labeled as normal MPI from June-2011 till March-2012 were included.  These patients were followed on telephone for seven years for cardiac events including fatal myocardial infarction (FMI) and nonfatal myocardial infarction (NFMI). Follow‑up was not available in 33 patients, leaving a cohort of 224 participants. Mean HbA1c was calculated for seven years. Patients were subdivided according to predefined cut-off value of HbA1c 7.3% as determined in previously published study by our group (57 in group A with HbA1c >7.3% and 167 in group B with HbA1c ≤ 7.3%). Results: No statistically significant difference was found in age, gender, body mass index, hypertension, dyslipidemia, family history, LV function, Bruce and vasodilator stress protocol in both groups except metabolic equivalent of task (METS) was significantly higher in group B (<0.05). Overall mean survival was significantly higher in group B with HbA1c ≤7.3 (Mean=80 vs. 71; CI=78-83 vs. 64-78 months in Group B and A respectively; log rank value=5.576; p <0.05). Significantly higher fatal and non-fatal cardiac events on seven years follow up were recorded in group A with HbA1c >7.3% with lower METS <7 (3 vs. 0 FMI and 11 vs. 9 NFMI and annualized event rate 0.75% vs. 0% and 2.8% vs. 0.76% group A and Group B respectively; p<0.05). Conclusion:  We conclude that a negative MPS has a significantly higher NPV and better effort tolerance in diabetics with good glycemic control (mean HbA1c ≤ 7.3%) than diabetics with impaired glycemic control (mean HbA1c >7.3%). Impaired glycemic control is supposed to be associated with impaired endothelial function and demands a correlative study in future.

Key word: Gated myocardial perfusion imaging; diabetics; HbA1C; METS, fatal MI; non-fatal MI.

Full Text:



. Krempf M, Parhofer KG, Steg PG, Bhatt DL, Ohman EM, Röther J, et. Reach Registry Investigators. Cardiovascular event rates in diabetic and nondiabetic individuals with and without established atherothrombosis (from the Education of Atherothrombosis for Continued Health [REACH] Registry). Am J Cardiol. 2010; 105: 667–71.

. Bonora E, Tuomilehto J. The pros and cons of diagnosing diabetes with A1C. Diabetes Care 2011; 34: S184-90.

. Kang X, Berman DS, Lewin H. Comparative ability of myocardial perfusion single photon emission computed tomography to detect coronary artery disease in patients with and without diabetes mellitus. Am Heart J 1999; 137:949-57.

. Fatima N, Zaman M, Ishaq M, Baloch DJ, Bano M, Bano S, et. Impact of glycosylated hemoglobin (HBA1C) on the extent of perfusion abnormalities and left ventricular dysfunction using gated myocardial perfusion imaging and clinical outcomes in diabetic patients. Nuclear Medicine Communications 2013, 34:489–94.

. Acampa Q, Cantoni V, Green G, Maio F, Daniele S, Nappi C, et al. Prognostic value of normal stress myocardial perfusion imaging in diabetic patients: A meta-analysis. J Nucl Cardiol 2014;21:893–902.

. Acampa W, Petretta M, Cuocolo R, Daniele S, Cantoni V, Cuocolo A. Warranty period of normal stress myocardial perfusion imaging in diabetic patients: A propensity score analysis. J Nucl Cardiol 2014; 21:50-6.

. Eeg-Olofsson K, Zethelius B, Gudbjörnsdottir S, Björn Eliasson, Ann-Marie Svensson, Jan Cederholm. Considerably decreased risk of cardiovascular disease with combined reductions in HbA1c, blood pressure and blood lipids in type 2 diabetes: report from the Swedish national diabetes Register. Diab Vasc Dis Res2016;13:268–77 (doi:10.1177/1479164116637311)

. Sarwar N, Aspelund T, Eiriksdottir G, Gobin R, Seshasai SR, Forouhi NG, et al. Markers of dysglycaemia and risk of coronary heart disease in people without diabetes: Reykjavik prospective study and systematic review. PLoS Med 2010; 7:e1000278

. Chen S, Shen Y, Liu Y, Dai Y, Wu Z, Wang X, et al. Impact of glycemic control on the association of endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2021; 20 : 64 (doi.org/10.1186/s12933-021-01257-y)


  • There are currently no refbacks.

© Copyright PJR 2008-