Schuijf Joanne D, Bax Jeroen J, Jukema J Wouter, Lamb Hildo J, Vliegen Hubert W, Salm Liesbeth P, de Roos Albert, van der Wall Ernst E
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
Diabetes Care. 2004 Dec;27(12):2905-10. doi: 10.2337/diacare.27.12.2905.
Early identification of coronary artery disease (CAD) in patients with diabetes is important because these patients are at increased risk for CAD and have worse outcome than nondiabetic patients after CAD is diagnosed. Recently, noninvasive coronary angiography and assessment of left ventricular function has been demonstrated with multislice computed tomography (MSCT). The purpose of the present study was to validate this approach in patients with type 2 diabetes.
MSCT was performed in 30 patients with confirmed type 2 diabetes. From the MSCT images, coronary artery stenoses (> or =50% luminal narrowing) and left ventricular function (left ventricular ejection fraction, regional wall motion) were evaluated and compared with results of conventional angiography and two-dimensional echocardiography.
Two hundred twenty of 256 coronary artery segments (86%) were interpretable with MSCT. In these segments, sensitivity and specificity for detection of coronary artery stenoses were 95%. Including the uninterpretable segments, sensitivity and specificity were 81 and 82%, respectively. Bland-Altman analysis in the comparison of left ventricular ejection fractions demonstrated a mean difference of -0.48 +/- 3.8% for MSCT and echocardiography, which was not significantly different from 0. Agreement between the two modalities for assessment of regional contractile function was excellent (91%, kappa statistic 0.81).
Accurate noninvasive evaluation of both the coronary arteries and left ventricular function with MSCT is feasible in patients with type 2 diabetes. This noninvasive approach may allow optimal identification of high-risk patients.
早期识别糖尿病患者的冠状动脉疾病（CAD）很重要，因为这些患者患CAD的风险增加，且在CAD被诊断后，其预后比非糖尿病患者更差。最近，多层螺旋计算机断层扫描（MSCT）已被证明可用于无创冠状动脉造影和左心室功能评估。本研究的目的是在2型糖尿病患者中验证这种方法。
对30例确诊的2型糖尿病患者进行了MSCT检查。从MSCT图像中评估冠状动脉狭窄（管腔狭窄≥50%）和左心室功能（左心室射血分数、节段性室壁运动），并与传统血管造影和二维超声心动图的结果进行比较。
256个冠状动脉节段中的220个（86%）可通过MSCT进行解读。在这些节段中，检测冠状动脉狭窄的敏感性和特异性为95%。包括不可解读的节段，敏感性和特异性分别为81%和82%。左心室射血分数比较的Bland-Altman分析显示，MSCT和超声心动图的平均差异为-0.48±3.8%，与0无显著差异。两种方法在评估节段性收缩功能方面的一致性极佳（91%，kappa统计量0.81）。
在2型糖尿病患者中，用MSCT对冠状动脉和左心室功能进行准确的无创评估是可行的。这种无创方法可能有助于最佳地识别高危患者。
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