Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 1, 50141, Florence, Italy.
Int J Cardiovasc Imaging. 2010 Jun;26(5):499-507. doi: 10.1007/s10554-010-9598-z. Epub 2010 Feb 14.
CAD is the main cause of morbidity and mortality in diabetic patients; we need reliable clinical parameters to stratify cardiovascular risk in these patients. We thus assessed prognostic value of clinical parameters, rest and stress echocardiographic data in diabetic patients, with known or suspected CAD. We studied 322 type 2 diabetic patients, who underwent dobutamine stress echocardiography (DSE) for known or suspected CAD; for prognostic assessment, end-points were all-cause mortality and hard cardiac events (cardiac death and non fatal myocardial infarction). During DSE, viability and inducible ischemia developed in 65 (20%) and 192 (60%) subjects, respectively; a severe ischemia (an asynergic area including more than 40% of all segments combined with a rate pressure product < 17,000) appeared in 88 (27%). Presence of a diabetic treatment or microvascular diabetic complications didn't influence prognosis, while a longer diabetes duration was associated with a higher all-cause mortality at univariate analysis. At multivariate analysis, an advanced age (RR = 1.108, CI: 1.039-1.182, P = 0.002), a lower left ventricular ejection fraction (RR = 0.956, CI: 0.919-0.994, P = 0.025) and, tendentially, peripheral vascular disease (RR = 2.942, CI: 0.985-8.785, P = 0.053) independently determined an increased all-cause mortality. New hard cardiac events occurred more frequently in presence of peripheral vascular disease (RR = 2.975, CI: 1.339-6.608, P = 0.007), viability (RR = 3.427, CI: 1.400-8.390, P = 0.007) and severe ischemia (RR = 3.245, CI: 1.503-7.005, P = 0.003). In diabetic patients with known or suspected CAD, presence of viability and severe ischemia during DSE are independently associated with higher occurrence of hard cardiac events.
CAD 是糖尿病患者发病和死亡的主要原因；我们需要可靠的临床参数来对这些患者的心血管风险进行分层。因此，我们评估了临床参数、静息和应激超声心动图数据在已知或疑似 CAD 的糖尿病患者中的预后价值。我们研究了 322 名 2 型糖尿病患者，他们因已知或疑似 CAD 而行多巴酚丁胺负荷超声心动图（DSE）检查；终点为全因死亡率和硬性心脏事件（心脏死亡和非致死性心肌梗死）。在 DSE 期间，分别有 65 名（20%）和 192 名（60%）患者出现存活心肌和可诱导缺血；88 名（27%）患者出现严重缺血（包括超过 40%节段的非同步区，同时压力-速率乘积＜17000）。糖尿病治疗或微血管糖尿病并发症的存在并不影响预后，而糖尿病病程较长与单因素分析时的全因死亡率升高相关。多因素分析显示，年龄较大（RR=1.108，95%CI：1.039-1.182，P=0.002）、左心室射血分数较低（RR=0.956，95%CI：0.919-0.994，P=0.025）以及，倾向于外周血管疾病（RR=2.942，95%CI：0.985-8.785，P=0.053）独立地决定了全因死亡率的增加。在外周血管疾病（RR=2.975，95%CI：1.339-6.608，P=0.007）、存活心肌（RR=3.427，95%CI：1.400-8.390，P=0.007）和严重缺血（RR=3.245，95%CI：1.503-7.005，P=0.003）存在的情况下，新发硬性心脏事件更常发生。在已知或疑似 CAD 的糖尿病患者中，DSE 期间存活心肌和严重缺血的存在与硬性心脏事件的发生有独立的相关性。
