心肌灌注单光子发射计算机断层扫描在糖尿病患者和非糖尿病患者中检测冠状动脉疾病的比较能力。

Comparative ability of myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in patients with and without diabetes mellitus.

作者信息

Kang X, Berman D S, Lewin H, Miranda R, Erel J, Friedman J D, Amanullah A M

机构信息

Departments of Imaging (Division of Nuclear Medicine) and Medicine(Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, CA, USA.

出版信息

Am Heart J. 1999 May;137(5):949-57. doi: 10.1016/s0002-8703(99)70421-7.

DOI:10.1016/s0002-8703(99)70421-7

PMID:10220646

Abstract

BACKGROUND

Diabetics generally have more frequent and extensive silent myocardial ischemia than nondiabetics, increasing the importance of noninvasive detection of coronary artery disease (CAD) in this cohort. However, little is known regarding the diagnostic accuracy of myocardial perfusion single-photon emission computed tomography (SPECT) in patients with diabetes. This study was undertaken to compare the diagnostic value of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT in patients with and without diabetes.

METHODS

Of the 203 patients with diabetes and 260 patients without diabetes who underwent dual-isotope myocardial perfusion SPECT with exercise or pharmacologic stress testing, 138 diabetics (12% type 1 diabetics) and 188 nondiabetics had coronary angiography within 6 months of the nuclear test, and 65 diabetics and 72 nondiabetics had a low likelihood (<10%, mean 6% +/- 3% and 6% +/- 3%) of CAD.

RESULTS

The angiographic data showed that patients with diabetes had less incidence of 1-vessel disease and a higher incidence of 3-vessel/left main artery disease than patients without diabetes (P <.05). The overall sensitivity and specificity, respectively, of SPECT for detecting CAD with the criterion of >/=50% diameter stenosis were 86% (95 of 111) and 56% (15 of 27) in diabetics, 86% (122 of 142) and 46% (21 of 46) in nondiabetics (P = not significant). With the criterion of >/=70% diameter stenosis the corresponding results were 90% (86 of 96) and 50% (21 of 42) in diabetics, and 91% (108 of 119) and 43% (30 of 69) in nondiabetics, respectively (P = not significant). The normalcy rate for low likelihood patients was 89% (58 of 65) in diabetics and 90% (65 of 72) in nondiabetics (P = not significant). The sensitivity and specificity for individual vessel detection were also similar in patients with and without diabetes (P = not significant) except for a lower sensitivity and a higher specificity for detecting left anterior descending coronary artery disease in the diabetic group (P <.05).

CONCLUSION

Dual-isotope myocardial perfusion SPECT has comparable accuracy for the diagnosis of CAD in diabetic and nondiabetic patients.

摘要

背景

糖尿病患者通常比非糖尿病患者有更频繁、更广泛的无症状心肌缺血，这增加了在该人群中无创检测冠状动脉疾病（CAD）的重要性。然而，关于糖尿病患者心肌灌注单光子发射计算机断层扫描（SPECT）的诊断准确性知之甚少。本研究旨在比较静息铊-201/负荷锝-99m 甲氧基异丁基异腈双核素心肌灌注 SPECT 在糖尿病患者和非糖尿病患者中的诊断价值。

方法

在 203 例糖尿病患者和 260 例非糖尿病患者中，这些患者接受了运动或药物负荷试验的双核素心肌灌注 SPECT，其中 138 例糖尿病患者（12%为 1 型糖尿病患者）和 188 例非糖尿病患者在核素检查后 6 个月内进行了冠状动脉造影，65 例糖尿病患者和 72 例非糖尿病患者患 CAD 的可能性较低（<10%，平均分别为 6%±3%和 6%±3%）。

结果

血管造影数据显示，糖尿病患者单支血管病变的发生率低于非糖尿病患者，而三支血管/左主干病变的发生率高于非糖尿病患者（P<.05）。以直径狭窄≥50%为标准，SPECT 检测 CAD 的总体敏感性和特异性在糖尿病患者中分别为 86%（111 例中的 95 例）和 56%（27 例中的 15 例），在非糖尿病患者中分别为 86%（142 例中的 122 例）和 46%（46 例中的 21 例）（P 无显著性差异）。以直径狭窄≥70%为标准，相应结果在糖尿病患者中分别为 90%（96 例中的 86 例）和 50%（42 例中的 21 例），在非糖尿病患者中分别为 91%（119 例中的 108 例）和 43%（69 例中的 30 例）（P 无显著性差异）。低可能性患者的正常率在糖尿病患者中为 89%（65 例中的 58 例），在非糖尿病患者中为 90%（72 例中的 65 例）（P 无显著性差异）。糖尿病患者和非糖尿病患者对各支血管检测的敏感性和特异性也相似（P 无显著性差异），但糖尿病组检测左前降支冠状动脉疾病的敏感性较低，特异性较高（P<.05）。