Smanio Paola Emanuela Poggio, Carvalho Antonio Carlos, Tebexreni Antonio Sergio, Thom Anneliese, Rodrigues Filadelfo, Meneghelo Romeu, Mastrocolla Luiz, Alves Alexandre, Piegas Leopoldo Soares, Paola Angelo Amato de
Instituto Dante Pazzanese de Cardiologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Arq Bras Cardiol. 2007 Nov;89(5):263-9, 290-7. doi: 10.1590/s0066-782x2007001700003.
Cardiovascular disease is the leading cause of morbidity and mortality among diabetic individuals. Myocardial ischemia is frequently asymptomatic, thus leading to a late diagnosis and worse prognosis. Diabetic women are known to have a cardiovascular death risk higher than that in men.
To assess the prevalence of coronary artery disease (CAD) in asymptomatic diabetic women. To compare the results of exercise test (ET), cardiopulmonary exercise test (CPET), and dipyridamole myocardial perfusion scintigraphy (MPS) with the findings of coronary angiography, (ANGI) in order of identify the most accurate method in the detection of significant CAD.
A total of 104 diabetic women were assessed with ET, CPET and MPS in the period within two months from the ANGI. MIBI-99mTc scintigraphy was performed using the gated-SPECT technique. Pearson's chi-square, Student's t tests were used for the statistical analysis and also the logistic regression analysis.
The prevalence of CAD in the group studied was 32.7%. For the ET, an effective test (p=0.045), the chronotropic incompetence (p=0.031), and the exercise time performed (p=0.022) showed a significant association with DAC. For CPET, peak VO2 and HR achieved were associated with CAD (p=0.004 and p=0.025, respectively). Most of the MPS variables showed a significant association with CAD (p=0.001, for all).
The results obtained may suggest a high prevalence of CAD in diabetic women. Thus, this population should be investigated from the cardiovascular point of view even without cardiac symptom. Of the noninvasive diagnostic methods used, dipyridamole MPS was the one that showed the highest discrimination power in relation to diabetic women with CAD.
心血管疾病是糖尿病患者发病和死亡的主要原因。心肌缺血通常无症状，从而导致诊断延迟和预后较差。已知糖尿病女性的心血管死亡风险高于男性。
评估无症状糖尿病女性冠状动脉疾病（CAD）的患病率。比较运动试验（ET）、心肺运动试验（CPET）和双嘧达莫心肌灌注显像（MPS）的结果与冠状动脉造影（ANGI）的结果，以确定检测显著CAD的最准确方法。
在冠状动脉造影前两个月内，对104名糖尿病女性进行了ET、CPET和MPS评估。使用门控SPECT技术进行99mTc-MIBI显像。采用Pearson卡方检验、Student t检验进行统计分析，并进行逻辑回归分析。
研究组CAD的患病率为32.7%。对于ET，有效试验（p=0.045）、变时功能不全（p=0.031）和运动时间（p=0.022）与DAC显著相关。对于CPET，峰值VO2和达到的心率与CAD相关（分别为p=0.004和p=0.025）。大多数MPS变量与CAD显著相关（所有p=0.001）。
所得结果可能提示糖尿病女性中CAD的患病率较高。因此，即使没有心脏症状，也应从心血管角度对该人群进行调查。在所使用的非侵入性诊断方法中，双嘧达莫MPS对患有CAD的糖尿病女性显示出最高的鉴别能力。
