Valensi Paul, Pariès Jacques, Brulport-Cerisier Valérie, Torremocha Florence, Sachs Régis-Nessim, Vanzetto Gérald, Cosson Emmanuel, Lormeau Boris, Attali Jean-Raymond, Maréchaud Richard, Estour Bruno, Halimi Serge
Department of Endocrinology-diabetology-Nutrition, Jean Verdier Hospital, Bondy Cedex, France.
Diabetes Care. 2005 Nov;28(11):2722-7. doi: 10.2337/diacare.28.11.2722.
Silent myocardial ischemia (SMI) in asymptomatic subjects with no history of myocardial infarction or angina is a frequent condition in diabetic patients. The aim of the study was to examine the predictive value of SMI for cardiac events in a multicenter cohort and to determine whether this value is higher in patients with a particular clinical profile.
A total of 370 asymptomatic diabetic patients with at least two additional cardiovascular risk factors was recruited in four departments of diabetology. SMI was assessed by either exercise or dipyridamole single-photon emission-computed tomography myocardial perfusion imaging with thallium-201. If dipyridamole stress was used, an electrocardiogram stress test was performed separately on another day. Follow-up duration was 3-89 months (38 +/- 23 months).
There was evidence of SMI in 131 patients (35.4%) on at least one positive noninvasive test. The patients with SMI were significantly older and had significantly higher serum triglycerides and lower HDL cholesterol levels. Cardiac events occurred in 53 patients (14.3%). Major cardiac events (death or myocardial infarction) occurred in 38 patients (10%) and other events (unstable angina, heart failure, or coronary revascularization) occurred in 15 patients. The patients who had cardiac events were older and had higher serum triglyceride levels at baseline. There was a significant association between SMI and cardiac events (hazard ratio 2.79 [95% CI 1.54-5.04]) and in particular major cardiac events (3 [1.53-5.87]). In the patients >60 years of age, the prevalence of SMI was higher (43.4 vs. 30.2% in those <60 years). SMI was associated with a significant risk of cardiac events (2.89 [1.31-6.39]) and in particular major cardiac events (3.66 [1.36-9.87]) for the patients >60 years old but not for those <60 years old.
In asymptomatic diabetic patients with additional cardiovascular risk factors, SMI is a potent predictor of cardiac events and should be assessed preferably in the patients >60 years of age.
在无心肌梗死或心绞痛病史的无症状受试者中,静息性心肌缺血(SMI)在糖尿病患者中很常见。本研究的目的是在一个多中心队列中检验SMI对心脏事件的预测价值,并确定该价值在具有特定临床特征的患者中是否更高。
在四个糖尿病科共招募了370例至少有另外两种心血管危险因素的无症状糖尿病患者。通过运动或双嘧达莫单光子发射计算机断层扫描心肌灌注显像(使用铊-201)评估SMI。如果使用双嘧达莫负荷试验,则在另一天单独进行心电图负荷试验。随访时间为3 - 89个月(38±23个月)。
131例患者(35.4%)至少有一项阳性非侵入性检查结果显示存在SMI。患有SMI的患者年龄显著更大,血清甘油三酯显著更高,高密度脂蛋白胆固醇水平更低。53例患者(14.3%)发生了心脏事件。主要心脏事件(死亡或心肌梗死)发生在38例患者(10%),其他事件(不稳定型心绞痛、心力衰竭或冠状动脉血运重建)发生在15例患者。发生心脏事件的患者年龄更大,基线时血清甘油三酯水平更高。SMI与心脏事件(风险比2.79 [95%置信区间1.54 - 5.04])尤其是主要心脏事件(3 [1.53 - 5.87])之间存在显著关联。在年龄大于60岁的患者中,SMI的患病率更高(43.4%对年龄小于60岁患者中的30.2%)。对于年龄大于60岁的患者,SMI与心脏事件(2.89 [1.31 - 6.39])尤其是主要心脏事件(3.66 [1.36 - 9.87])的显著风险相关,但对于年龄小于60岁的患者则不然。
在有额外心血管危险因素的无症状糖尿病患者中,SMI是心脏事件的有力预测指标,对于年龄大于60岁的患者应优先进行评估。