Prognostic Value of Normal Stress Myocardial Perfusion Imaging and Ventricular Function in Japanese Asymptomatic Patients With Type 2 Diabetes

atients with type 2 diabetes mellitus (DM) have a higher risk of cardiovascular events and death than those without the disease.1–6 Coronary artery disease (CAD) in diabetic patients is frequently silent.7–9 To maximize the effective treatment of cardiovascular disease in patients with DM, it is important to objectively identify CAD in asymptomatic subjects in a noninvasive way as early as possible.4–6 Risk stratification is essential for the development of evidence-based strategies for improved patient care for those with DM.5,6 The evaluation of known or suspected CAD using ECGgated myocardial perfusion single-photon emission computed tomography (SPECT) imaging has been established for diagnosis and risk assessment by many precedent studies.10–14 The Japanese Assessment of Cardiac Events and Survival Studies by quantitative gated SPECT (J-ACCESS) is the first large-scale prognostic study using myocardial perfusion imaging (MPI) of an Asian population.15–17 Cardiac event rates associated with normal or low-risk myocardial perfusion SPECT imaging with 99 mTc-tetrofosmin have been shown.17 Following the J-ACCESS study, J-ACCESS-2 began focusing on DM.18 In general, patients with normal SPECT images have a lower risk of death and hard cardiac events, whereas in those with abnormal MPI, the mortality and hard cardiac