Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Quality of life as predictor for the development of cardiac ischemia in high risk asymptomatic diabetic patients Philip Haaf, MD*1, Myriam Ritter, MD*1, Leticia Grize, PhD2, Matthias E. Pfisterer, MD1, Michael J. Zellweger, MD1, on behalf of the BARDOT study group 1Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; 2Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology BACKGROUND 1- Depression and psychosocial stress precede the development and influence the natural history of coronary heart disease. 2- We evaluated mental and physical quality of life (QoL) scores of diabetic patients screened for coronary artery disease and assessed their prognostic value to predict the development of new cardiac ischemia during a 2-year follow-up period. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study type: Prospective multicenter outcome study (substudy of BARDOT trial) Study subjects: Asymptomatic type 2 diabetic patients with neither history nor symptoms of CAD but at high risk of CAD as documented by end-organ damage, a combination of age >55 years, ≥2 cardiac risk factors, and >5 years duration of diabetes. Patient with NYHA IV were excluded. Study endpoints: Primary end point: Prognostic accuracy of QoL scores to predict the development of new cardiac ischemia in patients without ischemia (SDS<2) at baseline. Copyright American Society of Nuclear Cardiology

Quality of life scores at baseline Cardiovascular risk factors Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Cox proportional hazard analysis for prediction of new ischemia at 2 years of patients without ischemia at baseline (SDS at baseline < 2) Variable No new ischemia (n=295) New ischemia (n=11) Hazard Ratio (95% CI) p-value Quality of life scores at baseline HADS-D 3 [1-6] 8 [5-15] 1.213 (1.093-1.346) <0.001 HADS-A 5 [2-8] 8 [6-17] 1.217 (1.087-1.363) 0.001 SF 36-Mental 53 [46-58] 51 [31-54] 0.946 (0.905-0.989) 0.014 SF 36-Physical 48 [38-54] 50 [27-54] 0.978 (0.929-1.030) 0.406 Cardiovascular risk factors Diabetes duration, years 8 [5-14] 10 [6-10] 0.969 (0.882-1.064) 0.508 HbA1c (%) 7.0 [6.4-7.7] 7.6 [6.4-8.2] 1.127 (0.681-1.863) 0.642 Smoking (pack years) 20 [3-40] 35 [0-50] 1.010 (0.991-1.029) 0.295 Hypercholesterolemia 82 91 2.143 (0.274-16.739) 0.467 Hypertension 84 1.860 (0.238-14.533) 0.554 Family history 21 18 0.824 (0.178-3.813) 0.804 Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Quality of life scores in patients without ischemia and with ischemia at baseline (A+B) and at 2-year follow-up (C+D) illustrated by HADS-D (depression) and HADS-A (anxiety) scores with orange dashed line as cut-off value for depression and SF 36 mental and physical sum score. Boxes represent IQR’s, while whiskers display ranges (without outliers further than 1.5 IQR’s from the end of the box). BL denotes baseline. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS 1- QoL scores assessing mental health, particularly depression and anxiety, predicted the development of new cardiac ischemia in asymptomatic diabetic patients. 2- Clinicians might consider including core questions into their routine to screen for depression. 3- The study is limited by a small number of events (new ischemia) and so the results should be considered hypothesis generating rather than conclusive. Copyright American Society of Nuclear Cardiology