Myocardial perfusion imaging for evaluation of suspected ischemia and its relationship with glycemic control in South African subjects with diabetes mellitus

Figures & data

Table 1 Clinical and laboratory characteristics of the study subjects (n=340)

	No diabetes (n=146)	Diabetes (n=194)	P-value
Age (years)	55±11.2	58±9.5	0.01
Sex			NS
Male (n=211)	91 (62.3)	120 (61.9)
Female (n=129)	55 (37.7)	74 (38.1)
Ethnic group			NS
African (n=46)	24 (16.4)	22 (11.3)
Indian (n=246)	98 (67.1)	148 (76.2)
White (n=42)	21 (14.4)	21 (11)
Others (n=6)	3 (2.1)	3 (1.5)
Hypertension	84 (57.5)	163 (84)	<0.001
Dyslipidemia	91 (62.3)	150 (77.3)	<0.01
Smoking	91 (62.3)	111 (57.2)	NS
History of CAD	124 (84.9)	151 (77.8)	NS
Family history of diabetes	1 (0.7)	10 (5.2)	0.02
Treatment for hypertension	82 (56.2)	165 (85)	<0.001
Anti-ischemic treatment	123 (84.2)	154 (79.4)	NS
Lipid-lowering agents	134 (91.8)	187 (95.4)	NS
Aspirin treatment	132 (90.4)	172 (88.7)	NS
BMI (kg/m^Citation2)	27.9±5.8	29.7±6.2	<0.01
SBP (mmHg)	131±22	138±23	<0.01
DBP (mmHg)	75.79±12.39	76.07±12.25	NS
Plasma glucose (mmol/L)	5.5±0.6	8.7±2.8	<0.001
HbA1c (%, mmol/mol)	5.8 (40)±0.4	7.8 (62)±1.8	<0.001
Serum creatinine (μmol/L)	79.6±18.3	128.1±139.1	<0.001
Proteinuria or microalbuminuria	10 (6.8)	48 (24.7)	<0.001
Abnormal ECG	119 (81.5)	165 (85.1)	NS
Abnormal ETT	28 (19.2)	46 (23.7)	NS
Abnormal echocardiogram	102 (69.9)	139 (71.6)	NS
Abnormal echo wall motion	90 (62)	128 (66)	NS
Ejection fraction (%)	55±17	57±18	NS

Note: Results are expressed as the mean ± standard deviation or n (%).

Abbreviations: BMI, body mass index; CAD, coronary artery disease; DBP, diastolic blood pressure; ECG, electrocardiograph; ETT, exercise treadmill test; echo, echocardiographic; HbA_1c, glycated hemoglobin; SBP, systolic blood pressure; NS, not statistically significant.

Table 2 Comparison of subjects with normal and abnormal MPI results

	Normal MPI (n=74)	Abnormal MPI (n=266)	P-value
Age (years)	57±10	57±11	NS
Sex
Male (n=211)	29 (39.2)	182 (68.4)	<0.001
Female (n=129)	45 (60.8)	84 (31.6)
Diabetes	31 (41.9)	163 (61.3)	<0.01
Diabetes duration (years)	10±7	11 ±7	NS
Hypertension	57 (77)	190 (71.4)	NS
Dyslipidemia	48 (64.9)	193 (72.6)	NS
Smoking	34 (45.9)	168 (63.2)	<0.01
History of CAD	50 (67.6)	225 (84.6)	<0.01
Family history of diabetes	3 (4.1)	8 (3)	NS
Treatment for hypertension	56 (76)	191 (71.8)	NS
Anti-ischemic treatment	51 (69)	226 (85)	<0.01
Aspirin treatment	60 (81.1)	244 (91.7)	<0.01
Lipid-lowering agents	66 (89.2)	255 (95.8)	NS
BMI (kg/m^Citation2)	31±7	28±6	<0.01
SBP (mmHg)	144±25	132±21	<0.001
DBP (mmHg)	78±14	75±12	NS
Plasma glucose (mmol/L)	6.5±2.0	7.5±2.8	<0.001
HbA1c (%, mmol/mol)	6.2 (44)±1.0	7.1 (55)±1.8	<0.001
Total cholesterol (mmol/L)	4.29±0.87	4.64±1.2	<0.01
Proteinuria or microalbuminuria	11 (14.9)	47 (17.7)	NS
Abnormal ECG	54 (73)	230 (86.5)	0.02
Abnormal ETT	13 (17.6)	61 (23)	NS
Abnormal echocardiogram	42 (56.8)	199 (74.8)	<0.01
Abnormal echo wall motion	37 (50)	181 (68.6)	<0.01
Ejection fraction (%)	76±7	58±18	<0.001

Note: Results are expressed as mean ± standard deviation or n (%).

Abbreviations: BMI, body mass index; CAD, coronary artery disease; DBP, diastolic blood pressure; ECG, electrocardiograph; ETT, exercise treadmill test; echo, echocardiographic; HbA_1c, glycated hemoglobin; SBP, systolic blood pressure; MPI, myocardial perfusion imaging; NS, not statistically significant.

Table 3 Results of MPI in subjects with (n=194) and without diabetes mellitus (n=146)

MPI result	No diabetes (n=146)	Diabetes (n=194)	OR	95% CI	P-value
Abnormal MPI	99 (68)	166 (85.6)	2.81	1.65–4.78	<0.01
Ischemia*	62 (42.4)	125 (64.4)	5.46	3.27–9.11	<0.01
Mild	20 (32.3)	33 (26.4)	0.75	0.38–1.46	0.4
Moderate	12 (19.4)	12 (9.6)	0.44	0.18–1.05	0.06
Severe	30 (48.4)	80 (64)	1.89	1.02–3.51	0.04
Infarction	90 (61.6)	150 (77.3)	2.12	1.32–3.40	0.001

Notes: Results are expressed as n (%).

* Ischemia defined by summed difference score: mild 2–4.99, moderate 5–7, and severe >7.

Abbreviations: MPI, myocardial perfusion imaging; CI, confidence interval; OR, odds ratio.

Table 4 Myocardial perfusion imaging results in subjects with diabetes mellitus based on glycemic control

MPI result	Diabetes with HbA1c <7.0% (n=88)	Diabetes with HbA1c ≥7.0% (n=106)	OR	95% CI	P-value
Abnormal MPI	70 (79.5)	96 (90.6)	2.46	1.07–5.67	0.03
Ischemia*	49 (55.7)	76 (71.7)	2.01	1.11–3.66	0.02
Mild	18 (36.7)	15 (19.7)	0.42	0.18–0.95	0.03
Moderate	5 (10.2)	7 (9.2)	0.89	0.26–2.98	0.85
Severe	26 (53.1)	54 (71.1)	2.17	1.02–4.59	0.04
Infarction	59 (67)	91 (85.8)	2.98	1.47–6.03	0.002

Notes: Results are expressed as n (%).

* Ischemia defined by summed difference score: mild 2–4.99, moderate 5–7, and severe >7.

Abbreviations: MPI, myocardial perfusion imaging; CI, confidence interval; OR, odds ratio; HbA_1c, glycated hemoglobin.

Table 5 MPI results in subjects without diabetes (n=146) and those with diabetes and HbA_1c ≥7.0% (n=106)

MPI result	No diabetes (n=146)	Diabetes with HbA1c ≥7.0% (n=106)	OR	95% CI	P-value
Abnormal MPI	99 (68)	96 (90.6)	4.55	2.17–9.53	0.0001
Ischemia*	62 (42.4)	76 (71.7)	3.43	2.01–5.86	<0.0001
Mild	20 (32.3)	15 (19.7)	0.51	0.23–1.12	0.09
Moderate	12 (19.4)	7 (9.2)	0.42	0.15–1.14	0.09
Severe	30 (48.4)	54 (71.1)	2.61	1.29–5.28	0.007
Infarction	90 (61.6)	91 (85.8)	3.77	1.99–7.15	<0.0001

Notes: Results are expressed as n (%).

* Ischemia defined by summed difference score: mild 2–4.99, moderate 5–7, and severe >7.

Abbreviations: HbA_1c, glycated hemoglobin; MPI, myocardial perfusion imaging; CI, confidence interval; OR, odds ratio.

Table 6 Multiple linear regression analysis results

Risk factor	P-value
Age (years)	0.74
Sex	0.35
Ethnic group	0.06
Diabetes duration (years)	0.55
Hypertension	0.57
Dyslipidemia	0.52
Smoking	0.72
History of CAD	0.40
Family history of diabetes	0.95
Family history of CAD	0.34
BMI (kg/m^Citation2)	0.27
SBP (mmHg)	0.42
DBP (mmHg)	0.21
Plasma glucose (mmol/L)	0.19
HbA1c (%, mmol/mol)	0.29
Total cholesterol (mmol/L)	0.26
Triglycerides	1.00
HDL	0.47
LDL	0.09
Proteinuria or microalbuminuria	0.99

Abbreviations: BMI, body mass index; CAD, coronary artery disease; DBP diastolic blood pressure; HbA_1c, glycated hemoglobin; HDL, high-density lipoprotein; LDL, low-density lipoprotein; SBP, systolic blood pressure.

[No authors listed] Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Circulation 2002 106 3143 3421 12485966

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