De Lorenzo Andrea, Lima Ronaldo S L, Siqueira-Filho Aristarco G, Pantoja Mauricio R
Clementino Fraga Filho Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Am J Cardiol. 2002 Oct 15;90(8):827-32. doi: 10.1016/s0002-9149(02)02702-9.
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in diabetics. Early diagnosis of CAD and identification of high-risk subgroups, followed by appropriate therapy, may therefore enhance survival. This study sought to determine the value of stress myocardial perfusion single-photon emission computed tomography (SPECT) with technetium-99m sestamibi to detect perfusion defects and predict cardiac events in asymptomatic diabetics. One hundred eighty asymptomatic diabetics without known CAD who underwent 2-day stress technetium-99m sestamibi SPECT were followed up for 36 +/- 18 months. End points were defined as hard (myocardial infarction or cardiac death) or total events (myocardial infarction, cardiac death, or late revascularization). Logistic regression analysis evaluated clinical variables, type of stress, exercise treadmill test (ETT), and SPECT as predictors of end points. Perfusion defects were found in 26% of patients (15% reversible, 6% mixed, and 5% fixed). Clinical or ETT variables were not associated with perfusion defect type or with hard events. However, male gender predicted total events (chi-square 3.3; p = 0.01). An abnormal SPECT significantly increased the risk of hard events (chi-square 5.4; p = 0.001) and total events (chi-square 7.4; p = 0.0001). Extensive defects determined the highest risk of total events (chi-square 18.8; p = 0.0001). Event rates increased according to SPECT: 2% of hard events per year and 5% of total events per year in patients with normal SPECT versus 9% per year and 38% per year, respectively, in those with abnormal SPECT. Importantly, a normal SPECT identified a relatively low-risk subgroup of patients. Thus, stress technetium-99m sestamibi SPECT was useful in evaluating asymptomatic diabetics for the presence of CAD, and effectively risk-stratified this population.
冠状动脉疾病（CAD）是糖尿病患者发病和死亡的主要原因。因此，早期诊断CAD并识别高危亚组，随后进行适当治疗，可能会提高生存率。本研究旨在确定用锝-99m 甲氧基异丁基异腈进行负荷心肌灌注单光子发射计算机断层扫描（SPECT）检测灌注缺损并预测无症状糖尿病患者心脏事件的价值。对180例无已知CAD的无症状糖尿病患者进行了为期2天的负荷锝-99m 甲氧基异丁基异腈SPECT检查，并随访36±18个月。终点定义为严重事件（心肌梗死或心源性死亡）或总事件（心肌梗死、心源性死亡或晚期血运重建）。逻辑回归分析评估临床变量、负荷类型、运动平板试验（ETT）和SPECT作为终点的预测因素。26%的患者发现有灌注缺损（15%为可逆性，6%为混合性，5%为固定性）。临床或ETT变量与灌注缺损类型或严重事件无关。然而，男性性别可预测总事件（卡方检验=3.3；p = 0.01）。SPECT异常显著增加了严重事件（卡方检验=5.4；p = 0.001）和总事件（卡方检验=7.4；p = 0.0001）的风险。广泛缺损确定了总事件的最高风险（卡方检验=18.8；p = 0.0001）。事件发生率根据SPECT情况而增加：SPECT正常的患者每年严重事件发生率为2%，总事件发生率为5%，而SPECT异常的患者分别为每年9%和38%。重要的是，SPECT正常识别出了一个相对低风险的患者亚组。因此，负荷锝-99m 甲氧基异丁基异腈SPECT有助于评估无症状糖尿病患者是否存在CAD，并有效地对该人群进行风险分层。
