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Exercise Thallium Imaging in Patients With Diabetes MellitusPrognostic Implications
Jonathan Felsher, MD;
Marc D. Meissner, MD;
A-Hamid Hakki, MD;
Jaekyeong Heo, MD;
Sally Kane-Marsch, RN;
Abdulmassih S. Iskandrian, MD
Arch Intern Med. 1987;147(2):313-317.
Abstract
• We used exercise thallium 201 imaging in 123 patients with diabetes mellitus (77 men and 46 women, aged 56 ±8 years), 75% of whom had angina pectoris (typical or atypical). During exercise testing, 18 patients (15%) had angina pectoris, 28 (23%) had ischemic ST changes, and 69 (56%) had abnormal thallium images. During follow-up (up to 36 months), there were 12 cardiac events; four patients died of cardiac causes and eight had nonfatal acute myocardial infarction. Univariate and multivariate survival analysis identified two independent predictors of cardiac events: the event rate was significantly less in patients with normal images and exercise heart rate over 120 beats per minute than in patients with abnormal images and exercise heart rate of 120 beats per minute or less (0% vs 22%). The patients with abnormal images or exercise heart rate of 120 beats per minute or less had an intermediate event rate (11.5%). Furthermore, two of the 54 patients with normal images and ten of 69 patients with abnormal images had subsequent cardiac events. Thus, exercise thallium imaging is useful in risk stratification in patients with diabetes mellitus.
(Arch Intern Med 1987;147:313-317)
Author Affiliations
From the Likoff Cardiovascular Institute, Hahnemann University and Hospital, Philadelphia. Dr Iskandrian is now with the Philadelphia Heart Institute, Presbyterian-University of Pennsylvania Medical Center, Philadelphia.
Footnotes
Accepted for publication July 2, 1986.
Read in part before the 58th annual session of the American Heart Association, Washington, DC, Nov 14,1985.
Reprint requests to Philadelphia Heart Institute, Presbyterian-University of Pennsylvania Medical Center, 39th and Market streets, Philadelphia, PA 19104 (Dr Iskandrian).
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