Coronary Computed Tomography Angiography and SPECT in Asymptomatic Diabetes
Coronary Computed Tomography Angiography and SPECT in Asymptomatic Diabetes
The purpose of this study is to compare the difference of diagnostic efficiency between
 coronary CT angiography and myocardial perfusion single photon emission computerized
 tomography in asymptomatic patients with type 2 diabetes mellitus.
Coronary artery disease (CAD) is the leading cause of death in patients with diabetes.
 Patients with diabetes are known to have silent myocardial ischemia more frequently than
 those without diabetes. Furthermore, CAD in patients with diabetes frequently manifested in
 advance stage, and morbidity and mortality are higher than those without diabetes. Early
 screening and treatment of CAD in asymptomatic patients with diabetes might reduce high
 morbidity and mortality.

 Myocardial perfusion single photon emission computerized tomography (SPECT) is known as a
 gold standard method in detecting silent myocardial ischemia in asymptomatic patients with
 diabetes. Despite of the power of detecting myocardial ischemia functionally, there are
 limitations of SPECT in diagnosing subclinical coronary atherosclerosis anatomically. In
 recent advance in technology, coronary CT angiography (CTA) could detect subclinical coronary
 atherosclerosis. However, there is a paucity of information comparing the diagnostic power
 between SPECT and CTA.

 Therefore in our study, we compare the difference of diagnostic efficiency between coronary
 CT angiography and myocardial perfusion single photon emission computerized tomography in
 asymptomatic patients with type 2 diabetes mellitus.

 In this study, we will recruit asymptomatic patients with diabetes. At the time of
 enrollment, all patients will undergo two imaging studies (SPECT and CTA) within a few days
 apart. When patients had positive result in either study, they will undergo coronary
 angiography for confirmation. We will evaluate the results of two studies comparing with
 coronary angiography. When the patients are eligible for study, investigators will give
 information about the study and obtain written consent. The presence of chest pain symptom
 will be screened with Rose questionnaire. Medical history and physical examination will be
 performed, and baseline laboratory work-up will be performed. Investigators will evaluate the
 status of diabetic complication (retinopathy/nephropathy/cardiac autonomic neuropathy).
Inclusion Criteria:

 1. Type 2 diabetes mellitus

 2. Age 50 ~ 75 years

 3. Duration of diabetes: more than 5 years

 4. More than two of the following risk factors in addition to diabetes:

 1)dyslipidemia, 2)hypertension, 3)smoking, 4)family history of premature coronary artery
 disease

 Exclusion Criteria:

 1. Angina pectoris or anginal equivalent symptoms

 2. Insulin pump user or history of ketoacidosis

 3. History of myocardial infarction, heart failure, or coronary revascularization

 4. Electrocardiographic evidence of Q-wave myocardial infarction, ischemic ST- segment or
 T-wave changes, or complete left bundle branch block

 5. Uncontrolled arrythmia

 6. Hypersensitivity to contrast dye

 7. Renal failure