Myocardial Perfusion Scintigraphy for the Evaluation of Atypical Chest Pain - Likely Non-Cardiac - in Type 2 Diabetic Individuals with Systemic Hypertension

Background: Myocardial perfusion scintigraphy (MPS) is an essential diagnostic tool for evaluating coronary artery disease, particularly in high-risk populations such as hypertensive type 2 diabetic patients (T2DM). Despite its clinical relevance, there remains a significant gap in understanding its optimal application and diagnostic accuracy in this subgroup, warranting further research to refine risk stratification and improve patient outcomes. Objective: This study aimed to assess the prevalence of myocardial ischemic abnormalities in hypertensive T2DM, patients presenting with atypical chest pain and either normal resting electrocardiogram (ECG) or ventricular repolarization disturbances, through MPS. Methods: A total of 165 participants, comprising 50 men (30.3%) and 115 women (69.7%), with a mean age of 65.6 ± 6 years, underwent MPS using a 2-day protocol. Results : The results revealed that 63.0% of patients exhibited normal perfusion scans, while 37% demonstrated findings consistent with myocardial ischemia. Additionally, a subset of the cohort underwent exercise stress testing (90.9%), which yielded positive results for ischemia in 33.3% of cases. The agreement between MPS and exercise ECG was analyzed, revealing a moderate correlation (Kappa = 0.52; P < 0.001). Conclusion : These findings reinforce the clinical utility of MPS as a reliable diagnostic tool for detecting coronary artery disease in patients with T2DM and systemic hypertension who present with atypical chest pain, particularly in those with inconclusive findings on resting ECG.