Ditchburn C J, Hall J A, de Belder M, Davies A, Kelly W, Bilous R
Department of Cardiology, Division of Cardiothoracic Medicine, South Cleveland Hospital, Middlesbrough, UK.
Postgrad Med J. 2001 Jun;77(908):395-8. doi: 10.1136/pmj.77.908.395.
To determine whether diabetic patients with coronary artery disease are more likely to experience silent myocardial ischaemia than subjects without diabetes.
Patients undergoing coronary angiography at a regional cardiothoracic unit, identified as having diabetes from the local district diabetic register/database.
The coronary angiograms and exercise treadmill tests of 100 diabetic and 100 non-diabetic patients who all had significant coronary artery disease and maximal effort exercise tests were reviewed. Patients were individually matched for age group, gender, severity of coronary artery disease, and indication for treadmill test.
Significant coronary artery disease was defined as a stenosis of greater than 50% diameter in at least one of the major coronary artery segments. Exercise tests were graded as positive if the electrocardiographic (ECG) recording showed planar or downsloping ST segment depression of > or = 1 mm in more than two leads at 80 ms post J-point or if there was a blood pressure fall > or = 10 mm Hg after an initial rise. A negative exercise test was defined as one in which the subject experienced no pain, had no ECG changes after maximal effort and had a normal blood pressure response. Subjects who did not experience any form of typical angina-type pain during a positive exercise test were defined as having an episode of silent ischaemia. Patients with symptomatic ischaemia were those who experienced typical angina-type pain with accompanying ST segment changes. Patients with a negative exercise test were defined as having "undetermined ischaemia". This category included all those without ECG evidence of myocardial ischaemia during the exercise test (with or without accompanying chest pain).
In the diabetic patients, 34% had ECG evidence of silent ischaemia on treadmill testing compared with only 19% of the non-diabetic controls (p < 0.02).
This study shows that diabetic patients with proved coronary artery disease have a higher risk of developing silent myocardial ischaemia during exercise than non-diabetic patients.
确定患有冠状动脉疾病的糖尿病患者比无糖尿病患者更易发生无症状心肌缺血。
在一家地区心胸科单位接受冠状动脉造影的患者，通过当地地区糖尿病登记册/数据库确定为患有糖尿病。
回顾了100例糖尿病患者和100例非糖尿病患者的冠状动脉造影和运动平板试验，所有患者均患有严重冠状动脉疾病并进行了最大负荷运动试验。患者按年龄组、性别、冠状动脉疾病严重程度和运动平板试验指征进行个体匹配。
严重冠状动脉疾病定义为至少一个主要冠状动脉节段直径狭窄大于50%。如果心电图记录显示在J点后80毫秒时，两个以上导联出现水平或下斜型ST段压低≥1毫米，或者初始血压上升后血压下降≥10毫米汞柱，则运动试验判定为阳性。阴性运动试验定义为受试者无疼痛，最大负荷运动后心电图无变化且血压反应正常。在阳性运动试验中未经历任何形式典型心绞痛样疼痛的受试者定义为发生了一次无症状缺血发作。有症状性缺血的患者是指经历典型心绞痛样疼痛并伴有ST段改变的患者。运动试验阴性的患者定义为“缺血情况未确定”。这一类别包括所有在运动试验期间无心肌缺血心电图证据的患者（无论有无胸痛）。
在糖尿病患者中，34%在运动平板试验中有心电图证据显示无症状缺血，而非糖尿病对照组中这一比例仅为19%（p<0.02）。
本研究表明，已证实患有冠状动脉疾病的糖尿病患者在运动期间发生无症状心肌缺血的风险高于非糖尿病患者。
