Document Type : Original Article(s)

Authors

1 Al-Zahra Charity Hospital, Department of Cardiology Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

3 Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Autonomic nervous system dysfunction in diabetic patients can result in an atypical presentation of cardiovascular disease that can be missed. We aimed to use single-photon emission computed tomography (SPECT) to assess cardiovascular disease (CAD) in diabetic patients with atypical pain to determine whether the pain above reflects the CAD. 
Methods: Diabetic patients with atypical cardiac symptoms were referred to the SPECT department. Demographic data such as age, gender, diabetes status, and other underlying diseases were gathered. A myocardial perfusion scan was then performed. The results were recorded to evaluate the risk of myocardial ischemia and the degree of coronary artery involvement in a non-invasive manner. 
Results: The study included 222 (177 female) subjects with mean ages of 63.01±11.62 and 59.41±9.19 in positive and negative SPECT, respectively. The most common symptoms were atypical chest pain (51.8%), followed by shortness of breath (50.5%), nausea, and syncope (0.9%). Cardiac parameters, such as the summed stress score (SSS), summed rest score (SRS), total perfusion deficit in stress (TPD-s), total perfusion deficit in rest (TPD-r), were significantly higher in the group with coronary artery involvement (P<0.001). However, ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volumes (ESV) parameters were not (P=.0.328, 0.351, and 0.443, respectively).
Conclusions: The mere presence of diabetes does not necessitate any additional diagnostic tests beyond those required for the general population, and it is possible to follow a diagnostic course similar to that of the general population.

Highlights

The PubMed and Google Scholar links for Hamed Bazrafshan.

PubMed

Google Scholar

 

Keywords

1.    Valensi P, Henry P, Boccara F, Cosson E, Prevost G, Emmerich J, et al. Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. Diabetes Metab. 2021; 47(2): 101185.
2.    Moshfegh H, Tajeddini F, Pakravan HA, Mahzoon M, Yazdi EA, Drissi HB. A validated reduced-order dynamic model of nitric oxide regulation in coronary arteries. Comput Biol Med. 2021; 139: 104958.
3.    Hatamnejad MR, Heydari AA, Salimi M, Jahangiri S, Bazrafshan M, Bazrafshan H. The utility of SYNTAX score predictability by electrocardiogram parameters in patients with unstable angina. BMC Cardiovasc Disord. 2022; 22(1): 1-11.
4.    Sakboonyarat B, Rangsin R. Prevalence and associated factors of ischemic heart disease (IHD) among patients with diabetes mellitus: a nation-wide, cross-sectional survey. BMC cardiovasc Disord. 2018; 18(1): 151.
5.    Nematollahi MA, Askarinejad A, Asadollahi A, Salimi M, Moghadami M, Sasannia S, et al. Association and Predictive Capability of Body Composition and Diabetes Mellitus Using Artificial Intelligence: A cohort study. 2022. https://doi.org/10.21203/rs.3.rs-1675052/v1
6.    Jahangiri S, Mousavi SH, Hatamnejad MR, Salimi M, Bazrafshan H. Prevalence of non‐steroidal anti‐inflammatory drugs (NSAIDs) use in patients with hypertensive crisis. Health Sci Rep. 2022; 5(1): e483.
7.    Kim J-J, Hwang B-H, Choi IJ, Choo E-H, Lim S, Kim J-K, et al. Impact of diabetes duration on the extent and severity of coronary atheroma burden and long-term clinical outcome in asymptomatic type 2 diabetic patients: evaluation by coronary CT angiography. Eur Heart J Cardiovasc Imaging. 2015; 16(10): 1065-73.
8.    Abdul-Ghani M, DeFronzo RA, Del Prato S, Chilton R, Singh R, Ryder RE. Cardiovascular disease and type 2 diabetes: has the dawn of a new era arrived? Diabetes care. 2017; 40(7): 813-20.
9.    Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, et al. JCS 2018 guideline on diagnosis of chronic coronary heart diseases. Circ J. 2021; 85(4): 402-572.
10.    Statistics I. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Google Search. 2013.
11.    Omerbašić M, Glavić J, Mišković A, Bardak B, Cvitkušić Lukenda K, Miškić B. Silent Acute Myocardial Infarction In Diabetic Patients In Emergency Medicine. Acta Med Croatica. 2020; 74(Supl 1): 15-9.
12.    Balcıoğlu AS, Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: clinical manifestations, cardiovascular consequences, diagnosis and treatment. World J Diabetes. 2015; 6(1): 80-91.
13.    Akın H, Bilge Ö. Relationship between frontal QRS-T duration and the severity of coronary artery disease in who were non-diabetic and had stable angina pectoris. Anatol J Cardiol. 2021; 25(8): 572-578.
14.    van Oosterhout RE, de Boer AR, Maas AH, Rutten FH, Bots ML, Peters SA. Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta‐analysis. J Am Heart Assoc. 2020; 9(9):e 014733.
15.    Chang C-W, Liao K-m, Chang Y-T, Wang S-H, Chen Y-c, Wang G-C. The first harmonic of radial pulse as an early predictor of silent coronary artery disease and adverse cardiac events in type 2 diabetic patients. Cardiol Res Pract. 2018; 2018.
16.    Dewey M, Siebes M, Kachelrieß M, Kofoed KF, Maurovich-Horvat P, Nikolaou K, et al. Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia. Nat Rev Cardiol. 2020; 17(7): 427-50.
17.    Schinkel AF, Elhendy A, Van Domburg RT, Bax JJ, Valkema R, Roelandt JR, et al. Long-term prognostic value of dobutamine stress 99mTc-sestamibi SPECT: single-center experience with 8-year follow-up. Radiology. 2002; 225(3): 701-6.
18.    Valensi P, Henry P, Boccara F, Cosson E, Prevost G, Emmerich J, et al. Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. Diseases Metab. 2021; 47(2): 101185.
19.    Thuresson M, Jarlöv MB, Lindahl B, Svensson L, Zedigh C, Herlitz J. Symptoms and type of symptom onset in acute coronary syndrome in relation to ST elevation, sex, age, and a history of diabetes. Am Heart J. 2005; 150(2): 234-42.
20.    Abidov A, Rozanski A, Hachamovitch R, Hayes SW, Aboul-Enein F, Cohen I, et al. Prognostic significance of dyspnea in patients referred for cardiac stress testing. N Engl J Med. 2005; 353(18): 1889-98.
21.    Bazrafshan H. Translation of Goldberger’s clinical electrocardiography book (9th edition) to Persian. Moalefan Farhikhte Publication.(https://nashr.sums.ac.ir/view_book.php?book=764); 2017.
22.    Bergeron S, Ommen SR, Bailey KR, Oh JK, McCully RB, Pellikka PA. Exercise echocardiographic findings and outcome of patients referred for evaluation of dyspnea. J Am Coll Cardiol. 2004; 43(12): 2242-6.
23.    Giri S, Shaw LJ, Murthy DR, Travin MI, Miller DD, Hachamovitch R, et al. Impact of diabetes on the risk stratification using stress single-photon emission computed tomography myocardial perfusion imaging in patients with symptoms suggestive of coronary artery disease. Circulation. 2002; 105(1): 32-40.
24.    Maffei E, Seitun S, Martini C, Guaricci AI, Tarantini G, van Pelt N, et al. Prognostic value of CT coronary angiography in diabetic and non-diabetic subjects with suspected CAD: importance of presenting symptoms. Insights Imaging. 2011; 2(1): 25-38.
25.    Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR, et al. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography. J Am Soc Echocardiogr. 2020; 33(1): 1-41. e8.
26.    Marwick TH. Dyspnea and risk in suspected coronary disease. New England Journal of Medicine. 2005; 353(18): 1963-5.
27.    Long C, Xu H, Shen Q, Zhang X, Fan B, Wang C, et al. Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT?. Eur J Radiol. 2020; 126: 108961.
28.    Zellweger MJ, Maraun M, Osterhues HH, Keller U, Müller-Brand J, Jeger R, et al. Progression to overt or silent CAD in asymptomatic patients with diabetes mellitus at high coronary risk: main findings of the prospective multicenter BARDOT trial with a pilot randomized treatment substudy. JACC Cardiovasc Imaging. 2014; 7(10): 1001-10.
29.    Paillole C, Ruiz J, Juliard J, Leblanc H, Gourgon R, Passa P. Detection of coronary artery disease in diabetic patients. Diabetologia. 1995; 38(6): 726-31.
30.    Group ASC. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Eng J Med. 2018; 379(16): 1529-39.
31.    Rocca B, Patrono C. Aspirin in the primary prevention of cardiovascular disease in diabetes mellitus: A new perspective. Diabetes Res Clin pract. 2020;160:108008.
32.    Gupta M, Tummala R, Ghosh RK, Blumenthal C, Philip K, Bandyopadhyay D, et al. An update on pharmacotherapies in diabetic dyslipidemia. Prog Cardiovasc Dis. 2019; 62(4): 334-41.
33.    Akrami M, Izadpanah P, Bazrafshan M, Hatamipour U, Nouraein N, Drissi HB, et al. Effects of colchicine on major adverse cardiac events in next 6-month period after acute coronary syndrome occurrence; a randomized placebo-control trial. BMC Cardiovascular Disorders. 2021; 7;21(1): 583.