Scholte Arthur J H A, Schuijf Joanne D, Kharagjitsingh Antje V, Dibbets-Schneider Petra, Stokkel Marcel P, van der Wall Ernst E, Bax Jeroen J
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Nucl Med Mol Imaging. 2009 Apr;36(4):567-75. doi: 10.1007/s00259-008-0967-y. Epub 2008 Nov 5.
The purpose of this study was to evaluate the prevalence of an abnormal stress myocardial perfusion study in a cohort of truly asymptomatic patients with type 2 diabetes mellitus using myocardial perfusion imaging by means of single photon emission computed tomography (SPECT). Secondly, we determined which clinical characteristics may predict an abnormal stress myocardial perfusion study in this population.
A total of 120 asymptomatic patients (mean age 53+/-10 years) with type 2 diabetes mellitus and one or more risk factors for coronary artery disease were prospectively recruited from an outpatient diabetes clinic. All patients underwent myocardial perfusion imaging by means of adenosine (99m)Tc sestamibi SPECT. Images were evaluated for the presence of perfusion abnormalities as well as other nonperfusion abnormalities that may indicate extensive ischaemia, including left ventricular dysfunction (defined as a left ventricular ejection fraction <45%), transient ischaemic dilatation and adenosine-induced ST segment depression. Multivariable analysis was performed using a backward selection strategy to identify potential predictors for an abnormal stress myocardial perfusion study. Finally, all patients were followed up for 12 months to determine the occurrence of cardiovascular events: (1) cardiac death, (2) nonfatal myocardial infarction, (3) unstable angina requiring hospitalization, (4) revascularization, or (5) stroke.
Of the 120 patients, 40 (33%) had an abnormal stress study, including myocardial perfusion abnormalities in 30 patients (25%). In 10 patients (8%), indicators of extensive (possibly balanced ischaemia) were observed in the absence of abnormal perfusion. The multivariable analysis identified current smoking, duration of diabetes and the cholesterol/high-density lipoprotein (HDL) ratio as independent predictors of an abnormal stress study. During a follow-up period of 12 months six patients (5%) had a cardiovascular event.
The current study revealed a high prevalence of abnormal stress myocardial perfusion studies in patients with type 2 diabetes mellitus despite the absence of symptoms. In contrast to earlier studies, current smoking, duration of diabetes and the cholesterol/HDL ratio were identified as independent predictors of an abnormal study.
本研究旨在通过单光子发射计算机断层扫描（SPECT）心肌灌注成像评估一组真正无症状的2型糖尿病患者中异常应激心肌灌注研究的患病率。其次，我们确定了哪些临床特征可预测该人群中异常应激心肌灌注研究。
从门诊糖尿病诊所前瞻性招募了120例无症状的2型糖尿病患者（平均年龄53±10岁），这些患者有一个或多个冠状动脉疾病危险因素。所有患者均接受了腺苷（99m）Tc 司他米比SPECT心肌灌注成像。评估图像中是否存在灌注异常以及其他可能提示广泛缺血的非灌注异常，包括左心室功能障碍（定义为左心室射血分数<45%）、短暂性缺血性扩张和腺苷诱导的ST段压低。采用向后选择策略进行多变量分析，以确定异常应激心肌灌注研究的潜在预测因素。最后，对所有患者进行12个月的随访，以确定心血管事件的发生情况：（1）心源性死亡，（2）非致命性心肌梗死，（3）需要住院治疗的不稳定型心绞痛，（4）血管重建，或（5）中风。
120例患者中，40例（33%）应激研究异常，其中30例（25%）有心肌灌注异常。10例患者（8%）在无异常灌注的情况下观察到广泛（可能为平衡性缺血）的指标。多变量分析确定当前吸烟、糖尿病病程和胆固醇/高密度脂蛋白（HDL）比值为异常应激研究的独立预测因素。在12个月的随访期间，6例患者（5%）发生了心血管事件。
本研究显示，2型糖尿病患者尽管无症状，但异常应激心肌灌注研究的患病率很高。与早期研究不同，当前吸烟、糖尿病病程和胆固醇/HDL比值被确定为异常研究的独立预测因素。
