Service de diabétologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.
Diabetes Metab. 2010 Dec;36(6 Pt 1):463-9. doi: 10.1016/j.diabet.2010.06.005. Epub 2010 Sep 15.
This study aimed to compare the positive predictive value (PPV) of stress myocardial scintigraphy (SPECT) and of dobutamine echocardiography (DE) in the diagnosis of significant coronary artery stenosis (CAD) in asymptomatic type 2 diabetic patients, and to assess long-term clinical outcomes according to silent myocardial ischaemia (SMI) screening.
A total of 204 asymptomatic type 2 diabetic patients at high cardiovascular (CV) risk were prospectively randomized to undergo either SPECT (n=104) or DE (n=100). Coronary angiography was proposed in cases of SMI, with revascularization of suitable lesions. Intensive treatment of CV risk factors was prescribed for all patients. Death and myocardial infarction (MI) were recorded during the 3-year follow-up.
Clinical characteristics were similar in the two testing groups. The prevalence of SMI and significant CAD were 13% and 4%, respectively, in the SPECT group vs 11% and 5%, respectively, in the DE group (not significant [NS]). The PPV for the detection of significant CAD was 29% for SPECT and 45% for DE (NS). Seven patients (3%) underwent initial revascularization. The 3-year rate of CV death and MI was 2.5%, and similar in both groups.
Rates of SMI and significant CAD in asymptomatic high-risk type 2 diabetic patients receiving intensive care of risk factors are low, and SPECT and DE are similar in the detection of SMI and CAD. Coronary revascularization and intensive CV risk-factor therapy are associated with a low rate of adverse CV events at 3 years, whichever stress test was used.
本研究旨在比较应激心肌闪烁显像（SPECT）和多巴酚丁胺超声心动图（DE）在诊断无症状 2 型糖尿病患者中显著冠状动脉狭窄（CAD）的阳性预测值（PPV），并根据无症状性心肌缺血（SMI）筛查评估长期临床结局。
共前瞻性随机选择 204 名高心血管（CV）风险的无症状 2 型糖尿病患者，分别进行 SPECT（n=104）或 DE（n=100）检查。有 SMI 时行冠状动脉造影，并对合适病变进行血运重建。所有患者均接受 CV 危险因素强化治疗。在 3 年随访期间记录死亡和心肌梗死（MI）。
两组患者的临床特征相似。SPECT 组 SMI 和显著 CAD 的患病率分别为 13%和 4%，DE 组分别为 11%和 5%（无统计学差异 [NS]）。SPECT 检测显著 CAD 的 PPV 为 29%，DE 为 45%（无统计学差异 [NS]）。7 名患者（3%）接受了初始血运重建。3 年 CV 死亡和 MI 发生率为 2.5%，两组相似。
在接受危险因素强化治疗的无症状高危 2 型糖尿病患者中，SMI 和显著 CAD 的发生率较低，SPECT 和 DE 在检测 SMI 和 CAD 方面相似。无论使用哪种应激试验，冠状动脉血运重建和强化 CV 危险因素治疗均与 3 年后不良 CV 事件发生率低相关。
