Chrapko Beata, Kowalczyk Mariusz, Nocuń Anna, Nowakowski Andrzej, Zaorska-Rajca Janina
Department of Nuclear Medicine, Skubiszewski Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland.
Hell J Nucl Med. 2006 May-Aug;9(2):90-3.
The aim of this study was to assess the changes in hemodynamic function and myocardial perfusion of the left ventricle occurring in patients with type 1 diabetes mellitus (DM1) 47-49 months after the first assessment. We have studied 20 asymptomatic patients, five females and 15 males, aged 22-46 y. The patients were under intensive insulin treatment and had normal electrocardiogram (ECG) at rest. In all patients gated single photon emission tomography (GSPET) was performed at rest and after exercise (examination I). After 47-49 months this test was repeated (examination II). GSPET was performed 60 min after the intravenous injection of 740 MBq of technetium-99m 2-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI), using a dual-headed gamma-camera. Left ventricular ejection fraction (LVEF), end diastolic volume (EDV) and end systolic volume (ESV) were calculated using quantitative GSPET (QGS). The intensity of perfusion defects was also evaluated based on a four degree QGS scale. Our results were as follows: a) In examination I, performed at rest: LVEF was 56.1%+/-7.5%, EDV 96.9+/-25.8 ml and ESV 42.6+/-16.3 ml. b) In examination I at stress: LVEF was 57.2%+/-7.5%, EDV 94.1+/-24.0 ml and ESV 40.5+/-15.5. c) In examination II performed at rest: LVEF was 58.1%+/-6.5%, EDV 112.1+/-26.1 ml and ESV 46.6+/-14.9 ml and d) In examination II at stress: LVEF 57.8%+/-5.6%, EDV 107.9+/-27.4 ml and ESV 44.9+/-14.4 ml. Significant differences were found between examinations I and II, regarding: a) EDV at rest (P<0.001) and at stress (P<0.001) and b) ESV at rest (P<0.05) and at stress (P<0.005). Correlation analysis revealed significant correlation between LVEF at rest and at stress both in examination I (r=0.83; P<0.001) and also in examination II (r=-0.897; P<0.001). Intensity of myocardial perfusion defects in examination I at rest and at stress was: 1.68+/-0.5 and 2.2+/-0.6 degrees respectively. Intensity of myocardial perfusion defects in examination II at rest and at stress was: 1.75+/-0.4 and 2.2+/-0.5 respectively. No significant differences in the intensity of these perfusion defects were found. EDV both at rest and at stress was significantly higher in examination II as compared with the examination I study. Similar, but less pronounced changes of ESV were found. This study confirms other authors' observations on LV, EDV and LV, ESV and also that the percentage of asymptomatic DM1 patients having silent myocardial ischemia is high as was in all our patients. Nevertheless, in the current literature, we were unable to find a study similar to the present one, comparing basal and after four years LV functional GSPET data, in asymptomatic DM1 patients. In conclusion, myocardial perfusion GSPET was useful as a screening test in DM1 patients in showing four years after the basal study, prodromal signs of cardiovascular disease, especially increase of left ventricular volumes and silent myocardial ischemia, in these patients. Our research on the above protocol is being continued.
本研究的目的是评估1型糖尿病（DM1）患者在首次评估后47 - 49个月时左心室血流动力学功能和心肌灌注的变化。我们研究了20例无症状患者，其中5名女性和15名男性，年龄在22 - 46岁。患者接受强化胰岛素治疗，静息心电图（ECG）正常。所有患者在静息和运动后均进行了门控单光子发射断层扫描（GSPET）（检查I）。47 - 49个月后重复该检查（检查II）。静脉注射740 MBq的锝 - 99m 2 - 甲氧基 - 异丁基 - 异腈（（99m）Tc - MIBI）60分钟后，使用双头伽马相机进行GSPET检查。使用定量GSPET（QGS）计算左心室射血分数（LVEF）、舒张末期容积（EDV）和收缩末期容积（ESV）。还基于四级QGS量表评估灌注缺损的强度。我们的结果如下：a）在静息状态下进行的检查I中：LVEF为56.1%±7.5%，EDV为96.9±25.8 ml，ESV为42.6±16.3 ml。b）在运动状态下进行的检查I中：LVEF为57.2%±7.5%，EDV为94.1±24.0 ml，ESV为40.5±15.5 ml。c）在静息状态下进行的检查II中：LVEF为58.1%±6.5%，EDV为112.1±26.1 ml，ESV为46.6±14.9 ml；d）在运动状态下进行的检查II中：LVEF为57.8%±5.6%，EDV为107.9±27.4 ml，ESV为44.9±14.4 ml。在检查I和检查II之间发现了显著差异，具体如下：a）静息时的EDV（P < 0.001）和运动时的EDV（P < 0.001）；b）静息时的ESV（P < 0.05）和运动时的ESV（P < 0.005）。相关性分析显示，检查I中静息和运动时LVEF之间存在显著相关性（r = 0.83；P < 0.001），检查II中也存在显著相关性（r = -0.897；P < 0.001）。检查I中静息和运动时心肌灌注缺损的强度分别为1.68±0.5度和2.2±0.6度。检查II中静息和运动时心肌灌注缺损的强度分别为1.75±0.4度和2.2±0.5度。这些灌注缺损强度无显著差异。与检查I相比，检查II中静息和运动时EDV均显著更高。ESV也有类似但不太明显的变化。本研究证实了其他作者关于左心室、舒张末期容积和收缩末期容积的观察结果，并且我们所有患者中无症状DM1患者发生无症状心肌缺血的比例很高。然而，在当前文献中我们未能找到一项与本研究类似的，比较无症状DM1患者基础状态和四年后左心室功能GSPET数据的研究。总之，心肌灌注GSPET作为DM1患者的筛查试验很有用，它显示了基础研究四年后这些患者心血管疾病前驱症状，特别是左心室容积增加和无症状心肌缺血。我们正在继续按照上述方案进行研究。
