Choi Eue-Keun, Chun Eun Ju, Choi Sang-Il, Chang Sung-A, Choi Sung-Hee, Lim Soo, Rivera Juan J, Nasir Khurram, Blumenthal Roger S, Jang Hak-Chul, Chang Hyuk-Jae
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
Am J Cardiol. 2009 Oct 1;104(7):890-6. doi: 10.1016/j.amjcard.2009.05.026.
We evaluated the characteristics of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus (DM) using single photon emission computed tomography (SPECT) and coronary computed tomographic angiography (CCTA). A total of 116 patients with DM without abnormal electrocardiographic findings or evidence of peripheral arterial disease (number of risk factors > or =2; 62 +/- 7 years, 59% men) underwent CCTA and SPECT. Of the 116 patients with DM, 88 (76%) had a normal single photon emission computed tomographic findings, and 28 (24%) had abnormal perfusion defects. Of the 116 patients, 92 (79%) had atherosclerotic plaques (2 +/- 2 segments per subject), and 20 (17%) had significant stenosis seen on CCTA. Patients with DM and normal findings on SPECT had a similar prevalence of atherosclerotic plaque (78% vs 82%), significant stenosis (15% vs 25%), severe stenosis (7% vs 7%), and calcified (40% vs 43%), mixed (49% vs 57%), and noncalcified plaques (26% vs 29%) and a high (>100) coronary artery calcium score (32% vs 29%; all p >0.05) compared to those with abnormal findings on SPECT. During the mid-term follow-up (24 +/- 4 months), 5 cardiac events occurred in patients with DM and normal findings on SPECT, only in those with occult CAD on CCTA: 1 sudden cardiac death and 4 revascularization procedures. In conclusion, a significant percentage of patients with DM and normal eletrocardiographic findings, no peripheral arterial disease, and normal findings on SPECT have evidence of occult CAD on CCTA. Furthermore, a small percentage had had a cardiac event by mid-term follow-up. SPECT showed limited capability to differentiate the coronary risks between patients with DM and no coronary plaque and from those with a certain degree of disease; 2 circumstances that represent different coronary risks.
我们使用单光子发射计算机断层扫描（SPECT）和冠状动脉计算机断层血管造影（CCTA）评估了无症状2型糖尿病（DM）患者的冠状动脉疾病特征。共有116例无心电图异常或外周动脉疾病证据的DM患者（危险因素数量≥2；62±7岁，59%为男性）接受了CCTA和SPECT检查。在这116例DM患者中，88例（76%）单光子发射计算机断层扫描结果正常，28例（24%）有灌注缺损异常。116例患者中，92例（79%）有动脉粥样硬化斑块（每位受试者2±2节段），20例（17%）在CCTA上可见明显狭窄。SPECT检查结果正常的DM患者与SPECT检查结果异常的患者相比，动脉粥样硬化斑块的患病率相似（78%对82%）、明显狭窄（15%对25%）、严重狭窄（7%对7%）以及钙化斑块（40%对43%）、混合斑块（49%对57%）和非钙化斑块（26%对29%）的比例相似，且冠状动脉钙化评分>100的比例也相似（32%对29%；所有p>0.05）。在中期随访（24±4个月）期间，SPECT检查结果正常的DM患者中发生了5例心脏事件，且仅发生在CCTA上有隐匿性CAD的患者中：1例心源性猝死和4例血运重建手术。总之，相当比例的DM患者心电图结果正常、无外周动脉疾病且SPECT检查结果正常，但在CCTA上有隐匿性CAD的证据。此外，到中期随访时，有一小部分患者发生了心脏事件。SPECT显示区分无冠状动脉斑块的DM患者和有一定程度疾病的患者之间冠状动脉风险的能力有限；这两种情况代表了不同的冠状动脉风险。
