Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Cardiovascular Imaging Reports
Published in: Current Cardiovascular Imaging Reports 9/2015

01-09-2015 | Specific Populations and Emerging Markets (V Dilsizian and T. Schindler, Section Editors)

An Increasing Mexican Population with Metabolic Syndrome-Emerging Role of Hybrid SPECT/CT and PET/CT in Cardiovascular Disease Detection

Authors: Erick Alexanderson-Rosas, José Raúl Cruz-Mendoza, Gerardo Yoshiaki Guinto-Nishimura, Carlos Alberto Guízar-Sánchez, Salvador Hernández-Sandoval, Alejandro Francisco Barrero-Mier, Juan Carlos De La Fuente-Mancera, Mariano Oropeza-Aguilar, Sofía Jimena Canales-Albarrán, Christian González-Padilla, Andrea Monroy-González, Ricardo Martínez-Tapia, Aloha Meave-González

Published in: Current Cardiovascular Imaging Reports | Issue 9/2015

Login to get access

Abstract

Metabolic syndrome represents a growing burden in the Mexican population with an increasing presence as evidenced by the most recent epidemiological data, showing a prevalence of 49.8 % in 2006. The cardiovascular hazard of metabolic syndrome has been proven in numerous occasions; these patients present an increased risk of cardiovascular disease not only because of epicardial coronary occlusion but also from microvascular disease secondary to endothelial dysfunction. Myocardial perfusion imaging using both single-photon emission computed tomography and positron emission tomography can be effectively used for the evaluation of established coronary artery disease as well as in the assessment of high-risk asymptomatic patients. In this review, we briefly discuss the role of myocardial perfusion imaging studies and its current and potential applications for patients with metabolic syndrome.
Literature
1.
Mendis S, Puska P, Norrving B, editors. Global atlas on cardiovascular disease prevention and control. World Health Organ; 2011.
2.
INEGI. Instituto Nacional de Estadística y Geografía. Estadísticas de mortalidad 2012. 2012.
3.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–52.CrossRefPubMed
4.
International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. Int Diabetes Fed. 2006.
5.
Grundy SM. Metabolic syndrome scientific statement by the American Heart Association and the National Heart, Lung, and Blood Institute. Arterioscler Thromb Vasc Biol. 2005;25:2243–4.CrossRefPubMed
6.
González-Chávez A, Simental L, Elizondo-Argueta S, Sánchez-Zúñiga J, Gutiérrez Salgado G, Guerrero-Romero F. Prevalencia del síndrome metabólico entre adultos mexicanos no diabéticos, usando las definiciones de la OMS, NCEP-ATPIIIa e IDF. Rev Med Hosp Gen Mex. 2008;71:11–9.
7.
ENSANUT 2012: analysis of its main results. Salud Publica Mex. 2013;55 Suppl 2:S81–2.
8.
Rojas-Martinez R, Aguilar-Salinas CA, Jimenez-Corona A. Optimal cutoff points for the detection of undiagnosed type 2 diabetes, hypertension and metabolic syndrome in Mexican adults. Salud Publica Mex. 2012;54:13–9.PubMed
9.
Camarillo-Romero E, Dominguez Garcia MV, Amaya-Chavez A, Huitron-Bravo G, Majluf-Cruz A. Difficulties in the classification of metabolic syndrome. The example of adolescents in Mexico. Salud Publica Mex. 2010;52:524–7.PubMed
10.
Lin T, Liu J-C, Chang L-Y, Lee T-M. Association of metabolic syndrome and diabetes with subclinical coronary stenosis and plaque subtypes in middle-aged individuals. Diabet Med J Br Diabet Assoc. 2011;28:493–9.CrossRef
11.•
Vanhoutte PM. Endothelial dysfunction: the first step toward coronary arteriosclerosis. Circ J. 2009;73(4):595–601. In this study, Lin et al. demonstrated that both diabetic patients and patients with metabolic syndrome had a higher prevalence of atherosclerotic plaques and obstructed coronary arteries when compared with healthy subjects through tomographic computed angiographies. These observations suggest an accelerated development of subclinical atherosclerosis in patients with diabetes and metabolic syndrome.
12.•
Versari D, Daghini E, Virdis A, Ghiadoni L, Taddei S. Endothelial dysfunction as a target for prevention of cardiovascular disease. Diabetes Care. 2009;32 Suppl 2:S314–21. This is an excellent review covering extensively the topic of endothelial dysfunction, one of the main issues addressed in our article regarding initial abnormalities in metabolic syndrome patients. Besides from describing briefly how endothelial function is measured, it highlights its association with cardiovascular risk and clinical events. It also mentions the reversibility of endothelial dysfunction and its potential clinical applications.PubMedCentralCrossRefPubMed
13.
Prior JO, Quinones MJ, Hernandez-Pampaloni M, Facta AD, Schindler TH, Sayre JW, et al. Coronary circulatory dysfunction in insulin resistance, impaired glucose tolerance, and type 2 diabetes mellitus. Circulation. 2005;111:2291–8.CrossRefPubMed
14.
Guethlin M, Kasel AM, Coppenrath K, Ziegler S, Delius W, Schwaiger M. Delayed response of myocardial flow reserve to lipid-lowering therapy with fluvastatin. Circulation. 1999;99:475–81.CrossRefPubMed
15.
Anderson TJ. Assessment and treatment of endothelial dysfunction in humans. J Am Coll Cardiol. 1999;34:631–8.CrossRefPubMed
16.
Higuchi T, Abletshauser C, Nekolla SG, Schwaiger M, Bengel FM. Effect of the angiotensin receptor blocker Valsartan on coronary microvascular flow reserve in moderately hypertensive patients with stable coronary artery disease. Microcirc N Y N 1994. 2007;14:805–12.
17.
Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113:898–918.CrossRefPubMed
18.
19.
Saboor M, Moinuddin, Ajmal M, Ilyas S. Functional status of vascular endothelium in diabetes mellitus. J Ayub Med Coll Abbottabad JAMC. 2014;26:239–43.PubMed
20.
Schelbert HR. Coronary circulatory function abnormalities in insulin resistance: insights from positron emission tomography. J Am Coll Cardiol. 2009;53:S3–8.CrossRefPubMed
21.
Virdis A, Ghiadoni L, Versari D, Giannarelli C, Salvetti A, Taddei S. Endothelial function assessment in complicated hypertension. Curr Pharm Des. 2008;14:1761–70.CrossRefPubMed
22.
Avogaro A, Albiero M, Menegazzo L, de Kreutzenberg S, Fadini GP. Endothelial dysfunction in diabetes: the role of reparatory mechanisms. Diabetes Care. 2011;34 Suppl 2:S285–90.PubMedCentralCrossRefPubMed
23.
Zhao CT, Wang M, Siu CW, Hou YL, Wang T, Tse HF, et al. Myocardial dysfunction in patients with type 2 diabetes mellitus: role of endothelial progenitor cells and oxidative stress. Cardiovasc Diabetol. 2012;11:147.PubMedCentralCrossRefPubMed
24.
Rojas R, Aguilar-Salinas CA, Jimenez-Corona A, Shamah-Levy T, Rauda J, Avila-Burgos L, et al. Metabolic syndrome in Mexican adults: results from the National Health and Nutrition Survey 2006. Salud Publica Mex. 2010;52 Suppl 1:S11–8.CrossRefPubMed
25.
Partida Bush V. Proyecciones de la Población de México 2005-2050. Consejo Nacional de Población; 2006.
26.
Ibarra-Torres M, De la Cruz-Mendoza E, Torres-Rodríguez M, Aguilar-Zavala H, Garay S, Malacara J, et al. Contribución del nivel socioeconómico en la prevalencia del sindrome metabolico en población infantil del centro del país. Bioquimia. 2007;32.
27.
Jimenez-Cruz A, Velasco-Martínez RM, Bacardi-Gascon M, Higuera Dominguez F, Dominguez de la Piedra E. HOMA-IR, síndrome metabólico y hábitos dietéticos en adolescentes de Chiapas, México. Rev Biomed. 2009;20:82–8.
28.
Gutiérrez J, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, Cuevas-Nasu L, et al. Encuesta Nacional de Salud y Nutrición 2012. Resultados Nacionales. Inst Nac Salud Pública. 2013.
29.
30.
SSA. Encuesta Nacional de Enfermedades Crónicas 1993. Secr. Salud. 1994.
31.
Olaiz G, Rojas R, Barquera S, Shamah L, Sepúlveda J. Encuesta Nacional de Salud 2000. La Salud de los Adultos. Inst Nac Salud Pública. 2001.
32.•
Villalpando S, Shamah-Levy T, Rojas R, Aguilar-Salinas CA. Trends for type 2 diabetes and other cardiovascular risk factors in Mexico from. Salud Publica Mex. 2010;52 Suppl 1:S72–9. This is an excellent review covering extensively the topic of endothelial dysfunction, one of the main issues addressed in our article regarding initial abnormalities in metabolic syndrome patients. Besides from describing briefly how endothelial function is measured, it highlights its association with cardiovascular risk and clinical events. It also mentions the reversibility of endothelial dysfunction and its potential clinical applications.PubMed
33.
Olaiz G, Rivera J, Shamah T, Rojas R, Villalpando S, Hernádez-Avila M, et al. Encuesta Nacional de Salud y Nutrición 2006. Inst Nac Salud Pública. 2006.
34.
Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM, et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;63:380–406.CrossRefPubMed
35.
Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al. ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2010;2010:56.
36.
Shaw LJ, Berman DS, Hendel RC, Alazraki N, Krawczynska E, Borges-Neto S, et al. Cardiovascular disease risk stratification with stress single-photon emission computed tomography technetium-99m tetrofosmin imaging in patients with the metabolic syndrome and diabetes mellitus. Am J Cardiol. 2006;97:1538–44.CrossRefPubMed
37.
Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, et al. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: a bivariate meta-analysis. Circ Cardiovasc Imaging. 2012;5:700–7.CrossRefPubMed
38.
Zaret B, Beller G. Clinical nuclear cardiology: state of the art and future directions. 4th ed. 2010.
39.
Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD. J Am Coll Cardiol. 2004;43:200–8.CrossRefPubMed
40.
Anand DV, Lim E, Hopkins D, Corder R, Shaw LJ, Sharp P, et al. Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy. Eur Heart J. 2006;27:713–21.CrossRefPubMed
41.
Harshad K, Sathyamurthy I, Ashish G, Padma D, Shelley S, Indirani M, et al. Myocardial perfusion single photon emission computed tomography in asymptomatic diabetics. Indian Heart J. 2010;62:29–34.PubMed
42.
Miller TD, Rajagopalan N, Hodge DO, Frye RL, Gibbons RJ. Yield of stress single-photon emission computed tomography in asymptomatic patients with diabetes. Am Heart J. 2004;147:890–6.CrossRefPubMed
43.
Wackers FJT, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ, et al. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care. 2004;27:1954–61.CrossRefPubMed
44.
Nesto R. Screening for asymptomatic coronary artery disease in diabetes. Diabetes Care. 1999;22:1393–935.CrossRefPubMed
45.
Zellweger MJ, Hachamovitch R, Kang X, Hayes SW, Friedman JD, Germano G, et al. Prognostic relevance of symptoms versus objective evidence of coronary artery disease in diabetic patients. Eur Heart J. 2004;25:543–50.CrossRefPubMed
46.
Ghatak A, Padala S, Katten DM, Polk DM, Heller GV. Risk stratification among diabetic patients undergoing stress myocardial perfusion imaging. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2013;20:529–38.CrossRef
47.
De Lorenzo A, Lima RSL, Siqueira-Filho AG, Pantoja MR. Prevalence and prognostic value of perfusion defects detected by stress technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography in asymptomatic patients with diabetes mellitus and no known coronary artery disease. Am J Cardiol. 2002;90:827–32.CrossRefPubMed
48.
Djaberi R, Roodt J, Schuijf JD, Rabelink TJ, de Koning EJ, Pereira AM, et al. Endothelial dysfunction in diabetic patients with abnormal myocardial perfusion in the absence of epicardial obstructive coronary artery disease. J Nucl Med Off Publ Soc Nucl Med. 2009;50:1980–6.
49.
Wai MCGTJ, Ottenhof MJM, Boiten HJ, Valkema R, van Domburg RT, Schinkel AFL. Prediction of 8-year cardiovascular outcomes in patients with systemic arterial hypertension: value of stress (99m)Tc-tetrofosmin myocardial perfusion imaging in a high-risk cohort. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2013;20:1030–40.CrossRef
50.
Chin D, Battistoni A, Tocci G, Passerini J, Parati G, Volpe M. Non-invasive diagnostic testing for coronary artery disease in the hypertensive patient: potential advantages of a risk estimation-based algorithm. Am J Hypertens. 2012;25:1226–35.PubMed
51.
Freedman N, Schechter D, Klein M, Marciano R, Rozenman Y, Chisin R. SPECT attenuation artifacts in normal and overweight persons: insights from a retrospective comparison of Rb-82 positron emission tomography and TI-201 SPECT myocardial perfusion imaging. Clin Nucl Med. 2000;25:1019–23.CrossRefPubMed
52.
Prvulovich EM, Lonn AH, Bomanji JB, Jarritt PH, Ell PJ. Transmission scanning for attenuation correction of myocardial 201Tl images in obese patients. Nucl Med Commun. 1997;18:207–18.CrossRefPubMed
53.
Korbee RS, Boiten HJ, Ottenhof M, Valkema R, van Domburg RT, Schinkel AFL. What is the value of stress (99m)Tc-tetrofosmin myocardial perfusion imaging for the assessment of very long-term outcome in obese patients? J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2013;20:227–33.CrossRef
54.
Elhendy A, Schinkel AFL, van Domburg RT, Bax JJ, Valkema R, Biagini E, et al. Prognostic stratification of obese patients by stress 99mTc-tetrofosmin myocardial perfusion imaging. J Nucl Med Off Publ Soc Nucl Med. 2006;47:1302–6.
55.
Rana JS, Rozanski A, Berman DS. Combination of myocardial perfusion imaging and coronary artery calcium scanning: potential synergies for improving risk assessment in subjects with suspected coronary artery disease. Curr Atheroscler Rep. 2011;13:381–9.CrossRefPubMed
56.
Wong ND, Rozanski A, Gransar H, Miranda-Peats R, Kang X, Hayes S, et al. Metabolic syndrome and diabetes are associated with an increased likelihood of inducible myocardial ischemia among patients with subclinical atherosclerosis. Diabetes Care. 2005;28:1445–50.CrossRefPubMed
57.
Malik S, Wong ND, Franklin SS, Kamath TV, L’Italien GJ, Pio JR, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004;110:1245–50.CrossRefPubMed
58.•
Di Carli MF, Murthy VL. Cardiac PET/CT for the evaluation of known or suspected coronary artery disease. Radiogr Rev Publ Radiol Soc N Am Inc. 2011;31:1239–54. This article is relevant to our review because it discusses the advantages and limitations of PET/CT including its diagnostic accuracy and prognostic value. It also mentions the applicability of hybrid PET/CT scanners, conferring an increased diagnostic and prognostic capability.
59.
Dorbala S, Hachamovitch R, Curillova Z, Thomas D, Vangala D, Kwong RY, et al. Incremental prognostic value of gated Rb-82 positron emission tomography myocardial perfusion imaging over clinical variables and rest LVEF. JACC Cardiovasc Imaging. 2009;2:846–54.PubMedCentralCrossRefPubMed
60.•
Alexanderson E, Jacome R, Jimenez-Santos M, Ochoa JM, Romero E, Cabral MAP, et al. Evaluation of the endothelial function in hypertensive patients with 13N-ammonia PET. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2012;19:979–86. This article points out the presence of endothelial dysfunction in hypertensive patients in our population as measured by PET imaging studies. Hypertension needs not be associated to other comorbidities to own this burden.CrossRef
61.
Valenta I, Dilsizian V, Quercioli A, Schelbert HR, Schindler TH. The influence of insulin resistance, obesity, and diabetes mellitus on vascular tone and myocardial blood flow. Curr Cardiol Rep. 2012;14:217–25.CrossRefPubMed
62.•
Alexanderson E, Garcia-Rojas L, Jimenez M, Jacome R, Calleja R, Martinez A, et al. Effect of ezetimibe-simvastatine over endothelial dysfunction in dyslipidemic patients: assessment by 13N-ammonia positron emission tomography. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2010;17:1015–22. This article demonstrates that endothelial dysfunction, measured through PET imaging studies, is present in Mexican dyslipidemic patients. Furthermore, based on the results of the study, endothelial function could recover to values similar to those in healthy subjects after medical intervention.CrossRef
63.
Kjaer A, Meyer C, Nielsen FS, Parving H-H, Hesse B. Dipyridamole, cold pressor test, and demonstration of endothelial dysfunction: a PET study of myocardial perfusion in diabetes. J Nucl Med Off Publ Soc Nucl Med. 2003;44:19–23.
64.
Quinones MJ, Hernandez-Pampaloni M, Schelbert H, Bulnes-Enriquez I, Jimenez X, Hernandez G, et al. Coronary vasomotor abnormalities in insulin-resistant individuals. Ann Intern Med. 2004;140:700–8.CrossRefPubMed
65.
Calles-Escandon J, Cipolla M. Diabetes and endothelial dysfunction: a clinical perspective. Endocr Rev. 2001;22:36–52.CrossRefPubMed
66.•
Alexanderson-Rosas E, de Jesus Martinez A, Ochoa-Lopez JM, Calleja-Torres R, Sierra-Fernandez C, Inarra-Talboy F, et al. Effects of the combined treatment with metformin/glimepiride on endothelial function of patients with type 2 diabetes mellitus. A positron emission tomography (PET) evaluation study. Arch Cardiol Mex. 2009;79:249–56. This article is relevant for the review since it demonstrates the presence of endothelial dysfunction in recently diagnosed Mexican diabetic patients with no other comorbidities. Furthermore, it points out that this abnormality may improve after treatment with Metformin/Glimepiride.PubMed
67.
Alexanderson E, Rodriguez-Valero M, Martinez A, Calleja R, Lamothe PA, Sierra C, et al. Endothelial dysfunction in recently diagnosed type 2 diabetic patients evaluated by PET. Mol Imaging Biol. 2009;11:1–5.CrossRefPubMed
68.
Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. 1986;256:2823–8.CrossRefPubMed
69.
Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–47.CrossRefPubMed
Metadata
Title
An Increasing Mexican Population with Metabolic Syndrome-Emerging Role of Hybrid SPECT/CT and PET/CT in Cardiovascular Disease Detection
Authors
Erick Alexanderson-Rosas
José Raúl Cruz-Mendoza
Gerardo Yoshiaki Guinto-Nishimura
Carlos Alberto Guízar-Sánchez
Salvador Hernández-Sandoval
Alejandro Francisco Barrero-Mier
Juan Carlos De La Fuente-Mancera
Mariano Oropeza-Aguilar
Sofía Jimena Canales-Albarrán
Christian González-Padilla
Andrea Monroy-González
Ricardo Martínez-Tapia
Aloha Meave-González
Publication date
01-09-2015
Publisher
Springer US
Published in
Current Cardiovascular Imaging Reports / Issue 9/2015
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-015-9348-7

Other articles of this Issue 9/2015

Current Cardiovascular Imaging Reports 9/2015 Go to the issue

Cardiac Computed Tomography (TC Villines, Section Editor)

Transcaval TAVR—What the Radiologist Needs to Know

Cardiac Computed Tomography (TC Villines, Section Editor)

Cardiovascular Imaging for the Primary Prevention of Atherosclerotic Cardiovascular Disease Events

Cardiac Computed Tomography (TC Villines, Section Editor)

Cardiac CT in 2015: Clinical Role According to Current Multi-Societal Guidelines

Echocardiography (T Buck, Section Editor)

Hybrid Imaging During Transcatheter Structural Heart Interventions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits