Increased carotid intima-media thickness as seen on ultrasound independently predicted abnormal myocardial perfusion in diabetes patients who were otherwise asymptomatic for heart disease.
The finding suggests that “the truly noninvasive, inexpensive, and radiation-free nature of CIMT may represent an important advantage over other suggested screening techniques” for heart disease in diabetes patients.
Led by Dr. Roxana Djaberi of the department of cardiology at Leiden (the Netherlands) University Medical Center, the researchers looked at 98 patients with type 2 diabetes recruited from an outpatient diabetes clinic. All were asymptomatic for heart disease according to the Rose questionnaire (Diabetes Care 2009 Nov. 16 [doi:10.2337/dc09-1301]).
The patients' mean age was 54 years; 51% were male. Overall, the mean summed stress score (SSS) was 3.1, with 34 patients (35%) showing abnormal perfusion on single-photon emission computed tomography imaging (SSS greater than or equal to 3), and 14 patients (14%) showing severely abnormal perfusion (SSS of at least 8). According to Dr. Djaberi, “Abnormal perfusion was present in 9% of patients with normal CIMT versus 75% of patients with increased CIMT [defined as thickness at or above the 75th percentile of reference values].”
Moreover, “severely abnormal perfusion increased from 3% in patients with normal CIMT to 28% in those with increased CIMT,” she added.
The authors cited the lack of a nondiabetic control group as a study limitation.
Nevertheless, “Considering the high global prevalence of type 2 diabetes, a broad screening strategy of all asymptomatic patients using [single-photon emission computed tomography] perfusion imaging does not appear feasible or cost-effective,” concluded the authors.
“Initial risk-stratification using CIMT may allow selective referral of asymptomatic patients with type 2 diabetes requiring further imaging and intensification of therapy,” they added.
The authors received funding from Medtronic, Biotronik, Boston Scientific, Bristol Myers Squibb Medical Imaging, St. Jude Medical, GE Healthcare, Edwards Lifesciences, AstraZeneca, Pfizer, and MSD, an affiliate of Merck.