运动超声心动图在糖尿病患者中的预后价值。
Prognostic value of exercise echocardiography in diabetic patients.
作者信息
Oliveira Joselina L M, Barreto-Filho José A S, Oliveira Carla R P, Santana Thaiana A, Anjos-Andrade Fernando D, Alves Erica O, Nascimento-Junior Adão C, Góes Thiago J S, Santana Nathalie O, Vasconcelos Francis L, Barreto Martha A, D'Oliveira Junior Argemiro, Salvatori Roberto, Aguiar-Oliveira Manuel H, Sousa Antônio C S
机构信息
Department of Internal Medicine, Cardiology and Endocrinology Division, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
出版信息
Cardiovasc Ultrasound. 2009 May 29;7:24. doi: 10.1186/1476-7120-7-24.
BACKGROUND
Coronary artery disease (CAD) is the leading cause of death in diabetic patients. Although exercise echocardiography (EE) is established as a useful method for diagnosis and stratification of risk for CAD in the general population, there are few studies on its value as a prognostic tool in diabetic patients. The purpose of this investigation was to evaluate the value of EE in predicting cardiac events in diabetics.
METHODS
193 diabetic patients, 97 males, 59.8 +/- 9.3 yrs (mean +/- SD) were submitted to EE between 2001 and 2006 and followed from 7 to 65 months with median of 29 months by phone calls and personal interviews with patients and their primary physician, and reviewing medical records and death certificates. The end points were cardiac events, defined as non-fatal myocardial infarction, late myocardial revascularization and cardiac death. Sudden death without another explanation was considered cardiac death. Survival free of end points was estimated by the Kaplan-Meier method.
RESULTS
Twenty-six cardiac events were registered in 24 individuals during the follow-up. The rates of cardiac events were 20.6 and 7% in patients with positive and negative EE, respectively (p < 0.001). Predictors of cardiac events included sedentary lifestyle, with RR of 2.57 95%CI [1.09 to 6.02] (P = 0.03) and positive EE, with RR 3.63, 95%CI [1.44 to 9.16] (P = 0.01). Patients with positive EE presented higher rates of cardiac events at 12 months (6.8% vs. 2.2%), p = 0.004.
CONCLUSION
EE is a useful method to predict cardiac events in diabetic patients with suspected or known CAD.
背景
冠状动脉疾病（CAD）是糖尿病患者的主要死因。尽管运动超声心动图（EE）已被确立为一般人群中CAD诊断和风险分层的有用方法，但关于其作为糖尿病患者预后工具的价值的研究却很少。本研究的目的是评估EE在预测糖尿病患者心脏事件方面的价值。
方法
193例糖尿病患者，男性97例，年龄59.8±9.3岁（平均±标准差），于2001年至2006年间接受了EE检查，并通过电话、与患者及其主治医生的个人面谈以及查阅病历和死亡证明进行了7至65个月的随访，中位数为29个月。终点为心脏事件，定义为非致命性心肌梗死、晚期心肌血运重建和心源性死亡。无其他解释的猝死被视为心源性死亡。采用Kaplan-Meier法估计无终点事件的生存率。
结果
随访期间，24例患者发生了26次心脏事件。EE阳性和阴性患者的心脏事件发生率分别为20.6%和7%（p<0.001）。心脏事件的预测因素包括久坐不动的生活方式，相对危险度为2.57，95%可信区间[1.09至6.02]（P=0.03），以及EE阳性，相对危险度为3.63，95%可信区间[1.44至9.16]（P=0.01）。EE阳性的患者在12个月时心脏事件发生率更高（6.8%对2.2%），p=0.004。
结论
EE是预测疑似或已知CAD的糖尿病患者心脏事件的有用方法。
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