Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
JACC Cardiovasc Imaging. 2010 Jul;3(7):734-45. doi: 10.1016/j.jcmg.2010.06.001.
The aim of this study was to evaluate the impact of renal function by estimated glomerular filtration rate (eGFR) on risk stratification of diabetic and nondiabetic patients undergoing myocardial perfusion imaging (MPI) by single-photon emission computed tomography for suspected ischemia.
Coronary artery disease is the leading cause of death among diabetic persons; however, diabetic persons are a very heterogeneous group in terms of cardiovascular risk, necessitating further risk stratification.
Patients (n = 1,747, age 65 +/- 10 years, 37% diabetic) undergoing MPI were followed for cardiac death (CD) for a mean of 2.15 +/- 0.8 years. Chronic kidney disease (CKD) was defined by an eGFR <60 ml/min.
In the presence of a normal scan, annual CD rate was 0.9% for those with no diabetes mellitus (DM) and no CKD, 0.5% in the DM alone group, 2.35% in CKD alone, and 2.9% in those with both DM and CKD (p < 0.001). Patients with DM+CKD had a 2.7-fold risk of CD compared with no DM no CKD (p = 0.001) after controlling for age, ejection fraction, history of coronary artery disease, and other risk factors. The risk of CD increased as a function of the presence and severity of perfusion defects, regardless of CKD or DM status. Presence of CKD conferred a several-fold higher risk of CD for the various strata of perfusion defects. Log-rank test for difference in probability of CD was nonsignificant for comparison between patients with no DM no CKD and those with DM alone (p = 0.73) but was significant for comparison between patients with no DM no CKD and patients with CKD alone (p < 0.001) or DM+CKD (p < 0.001).
MPI and eGFR provide valuable risk stratification for diabetic and nondiabetic patients. Diabetic patients without CKD seem to have similar short-term cardiac outcomes compared with nondiabetic patients. Underlying CKD seems to identify a high-risk subgroup of diabetic patients.
本研究旨在评估估算肾小球滤过率（eGFR）对疑似缺血性接受单光子发射计算机断层扫描心肌灌注成像（MPI）的糖尿病和非糖尿病患者的风险分层的影响。
冠心病是糖尿病患者死亡的主要原因；然而，糖尿病患者在心血管风险方面是一个非常异质的群体，需要进一步的风险分层。
对 1747 名（年龄 65 +/- 10 岁，37%为糖尿病患者）接受 MPI 的患者进行随访，平均随访时间为 2.15 +/- 0.8 年，以评估心脏死亡（CD）的发生率。慢性肾脏病（CKD）定义为 eGFR <60ml/min。
在扫描结果正常的情况下，无糖尿病（DM）和无 CKD 的患者年 CD 发生率为 0.9%，DM 单独组为 0.5%，CKD 单独组为 2.35%，DM 和 CKD 均存在的患者为 2.9%（p < 0.001）。在校正年龄、射血分数、冠心病病史和其他危险因素后，与无 DM 无 CKD 的患者相比，DM+CKD 的患者 CD 的风险增加了 2.7 倍（p = 0.001）。CD 的风险随着灌注缺陷的存在和严重程度的增加而增加，无论 CKD 或 DM 状态如何。CKD 的存在为各种灌注缺陷的患者增加了数倍的 CD 风险。DM 无 CKD 患者与 DM 单独组患者之间（p = 0.73）、DM 无 CKD 患者与 CKD 单独组患者之间（p < 0.001）或 DM+CKD 患者之间（p < 0.001）CD 发生率的差异的对数秩检验均无统计学意义。
MPI 和 eGFR 为糖尿病和非糖尿病患者提供了有价值的风险分层。无 CKD 的糖尿病患者与非糖尿病患者的短期心脏结局似乎相似。潜在的 CKD 似乎确定了糖尿病患者的一个高风险亚组。
