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Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men

Impact of diabetes mellitus on incremental prognostic value and effect on patient management

Daniel S. Berman, MD, FACC^*,*, Xingping Kang, MD^*, Sean W. Hayes, MD^*, John D. Friedman, MD, FACC^*, Ishac Cohen, PhD^*, Aiden Abidov, MD^*, Leslee J. Shaw, PhD, Aman M. Amanullah, MD^*, Guido Germano, PhD, FACC^* and Rory Hachamovitch, MD, MSc, FACC^*

^* Departments of Imaging (Division of Nuclear Medicine), Department of Medicine (Division of Cardiology), and CSMC Burns and Allen Research Institute, Cedars-Sinai Medical Center, and the Department of Medicine, University of California Los Angeles, School of Medicine, Los Angeles, California, USA
Atlanta Cardiovascular Research Institute, Atlanta, Georgia, USA

View larger version (17K): [in a new window]   Figure 1 Annual rates of cardiac death in women (open bars) and men (solid bars) as a function of myocardial perfusion single-photon emission computed tomography results. *p < 0.001 across scan categories. abnl = abnormal; Mod = moderate; Sev = severe.

View larger version (11K): [in a new window]   Figure 2 Unadjusted two-year Kaplan-Meier survival estimates in men and women as a function of summed stress score. No significant difference is present.

View larger version (14K): [in a new window]   Figure 3 Chi-square values from the Cox proportional hazards models for the overall cohort, women, and men. Increase in chi-square is significant in all (*p < 0.0001). Solid bar = pre-MPS; open bar = pre-MPS + SSS.

View larger version (20K): [in a new window]   Figure 4 (A) Predicted cardiac mortality based on Cox proportional hazards model in nondiabetic men and women with normal, mildly, moderately, and severely abnormal scans. Significant difference in mortality as a function of increasing summed stress score (SSS) as based on the multivariable model (p < 0.0001). (B) Predicted cardiac mortality based on Cox proportional hazards model in diabetic men and women with normal, mildly, moderately, and severely abnormal scans. Significant difference in mortality as a function of increasing SSS as based on the multivariable model (p < 0.0001). abnl = abnormal; Mod = moderate; Sev = severe. Solid bar = men; open bar = women.

View larger version (22K): [in a new window]   Figure 5 Cardiac mortality in patients without diabetes mellitus (DM) (solid bar), with non–insulin-dependent diabetes mellitus (NIDDM) (open bar), and with insulin-dependent diabetes mellitus (IDDM) (hatched bar) after normal versus abnormal myocardial perfusion single-photon emission computed tomography (MPS). *p < 0.05 among non–DM, NIDDM, and IDDM within MPS categories; p < 0.05 between normal and abnormal MPS.

View larger version (12K): [in a new window]   Figure 6 Relationship between log relative hazard for predicted cardiac mortality and summed stress score in insulin-dependent diabetes mellitus (IDDM), non–insulin-dependent diabetes mellitus (NIDDM), and nondiabetics. p < 0.001.