الفهرس 
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Abstract
Introduction:
Coronary atherosclerosis develops earlier in diabetic patients
than in other subjects and accounts for excess morbidity and mortality in
these patients.
In patients with Acute Coronary Syndrome (ACS), addition of
gating to routine myocardial perfusion SPECT provides additional
information that can not be obtained by perfusion imaging alone. It
provides accurate and reproducible information on left ventricular
function and volume.
Aim of the study:
To assess the difference between the resting and post-stress
gated SPECT functional parameters and transient ischemic dilatation as
independent non perfusion risk markers for the evaluation of the severity
of coronary artery disease in diabetic patients with acute coronary
syndrome.
Patients and methods:
This study included 30 consecutive diabetic patients referred to
the CCU Department of Ain Shams University Hospital & Beni-suef
University Hospital with one of the acute coronary syndromes including
ST-segment elevation myocardial infarction (STEMI), non–ST-segment
elevation myocardial infarction (NSTEMI) and unstable angina.
Each patient was subjected to the following:
- Clinical assessment.
- 12-lead resting ECG.
- Echocardiographic examination.
Summary
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- Gated SPECT:
Using dual head CardioMD gamma camera linked to SMV power station ,
Stress and rest Technetium-99m Sestamibi GSPECT myocardial perfusion imaging
was performed to all patients included in the study .
- Coronary angiography:
Coronary angiography was done only for patients with stress myocardial
perfusion imaging showing reversible defects and either post stress depression of
ejection fraction (EF) or transient ischemic dilatation (TID). The results of coronary
angiography were compared with those predicted by Technetium -99m SPECT
imaging as well as the post stress changes in functional indices or transient ischemic
dilatation.
Results:
Our results showed that Post-exercise worsening of LVEF or TID
is more likely to detect multivessel CAD than reversible perfusion defects
alone. The worsening of the LVEF(worsening of EF ≥ 5% ) or Transient
Ischemic Dilatation (TID ratio ≥ 1.2 ) had significantly increased
sensitivity in detecting multivessel CAD over Tc-99 m perfusion defects
(100% ,95% Vs 80.9% , respectively ). However, the specificity between
both was not significantly different (95%, 100% Vs 100%).
Our results also showed that the magnitude of the post-stress
global dysfunction correlates with the severity of the ischemia: the
sensitivity for detection of multivessel CAD at TID ratio ≥1.2 was higher
than that at ≥1.4 (95% Vs 80.9%). Also the sensitivity for detection of
multivessel CAD in patient with post stress worsening of EF ≥ 5%was
higher than at ≥6% (100% Vs 95%).