Scholte Arthur J H A, Schuijf Joanne D, Kharagjitsingh Antje V, Dibbets-Schneider Petra, Stokkel Marcel P, Jukema J Wouter, van der Wall Ernst E, Bax Jeroen J, Wackers Frans J T
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
J Nucl Cardiol. 2008 Jul-Aug;15(4):503-9. doi: 10.1016/j.nuclcard.2008.02.015. Epub 2008 Apr 21.
We sought to assess prospectively the evidence for silent coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes mellitus by stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging, coronary artery calcium (CAC) scoring, and multislice computed tomographic (MSCT) coronary angiography.
One hundred asymptomatic patients (aged 30 to 72 years) with type 2 diabetes mellitus and one or more risk factors for CAD were prospectively recruited from an outpatient diabetes clinic. All patients underwent adenosine technetium-99m sestamibi SPECT imaging, CAC scoring, and 64-slice MSCT coronary angiography.
Twenty-three patients (23%) had abnormal stress SPECT imaging, consistent with inducible myocardial ischemia, whereas 60 patients (60%) had positive CAC scoring (18 patients [18%] with significant CAC >401), and 70 patients (70%) had abnormal MSCT coronary angiography (24 patients [24%] with significant, >or=50% stenosis). Of 77 patients with normal SPECT, 44 had a positive CAC score (10 patients [13%] >401), and 54 showed CAD on MSCT angiography (16 patients [21%] with >or=50% stenosis). Of 23 patients with an abnormal SPECT, 16 patients had a positive CAC score (8 patients [35%] >401), and 16 patients had CAD on MSCT angiography (8 patients [35%] with >or=50% stenosis). Overall, 17 patients (17%) had more than 2 significantly abnormal diagnostic test results, and 5 patients had three tests with significantly abnormal results.
In this cohort of asymptomatic patients with type 2 diabetes mellitus, different modalities visualized different aspects of silent coronary atherosclerosis. Anatomic evidence of coronary atherosclerosis (CAC and MSCT) occurred more frequently than functional evidence (stress SPECT). However, clinically significant manifestations of CAD were observed in about one-quarter to one-fifth of patients by each modality, either separately or combined. The relative prognostic value of each modality needs to be determined by a follow-up of this cohort.
我们试图通过负荷单光子发射计算机断层扫描（SPECT）心肌灌注成像、冠状动脉钙化（CAC）评分和多层计算机断层扫描（MSCT）冠状动脉造影，前瞻性地评估无症状2型糖尿病患者隐匿性冠状动脉疾病（CAD）的证据。
从一家门诊糖尿病诊所前瞻性招募了100例年龄在30至72岁之间、患有2型糖尿病且有一个或多个CAD危险因素的无症状患者。所有患者均接受了腺苷-锝99m甲氧基异丁基异腈SPECT成像、CAC评分和64层MSCT冠状动脉造影。
23例患者（23%）负荷SPECT成像异常，符合诱发性心肌缺血，而60例患者（60%）CAC评分阳性（18例患者[18%]有显著的CAC>401），70例患者（70%）MSCT冠状动脉造影异常（24例患者[24%]有显著的、≥50%狭窄）。在77例SPECT正常的患者中，44例CAC评分阳性（10例患者[13%]>401），54例在MSCT血管造影中显示有CAD（16例患者[21%]有≥50%狭窄）。在23例SPECT异常的患者中，16例患者CAC评分阳性（8例患者[35%]>401），16例患者在MSCT血管造影中有CAD（8例患者[35%]有≥50%狭窄）。总体而言，17例患者（17%）有超过2项显著异常的诊断测试结果，5例患者三项测试结果均显著异常。
在这组无症状2型糖尿病患者中，不同的检查方式显示了隐匿性冠状动脉粥样硬化的不同方面。冠状动脉粥样硬化的解剖学证据（CAC和MSCT）比功能学证据（负荷SPECT）出现得更频繁。然而，每种检查方式单独或联合使用时，在约四分之一至五分之一的患者中观察到了CAD的临床显著表现。每种检查方式的相对预后价值需要通过对该队列的随访来确定。
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