Le Feuvre Claude, Jacqueminet Sophie, Barthelemy Olivier
Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, 47-83 Bd de l'hôpital, 75651 Paris Cedex 13, France.
Future Cardiol. 2011 Mar;7(2):183-90. doi: 10.2217/fca.10.127.
The prevalence of diabetes mellitus is increasing consistently. Coronary artery disease (CAD) is the main cause of death; however, silent myocardial ischemia (SMI) is more frequent in diabetic patients. Early CAD diagnosis provided by SMI screening could lead to decreased cardiovascular complications and mortality. Current guidelines recommend screening for SMI in asymptomatic diabetic patients selected on a basis of high cardiovascular risk, followed by coronary angiogram in case of a positive stress test. However, the benefit of systematic SMI screening has not been demonstrated in diabetic patients with optimal treatment of risk factors. The benefit of revascularization in diabetic patients with SMI seems to be restricted to patients with severe CAD. Prospective studies are required to identify diabetic patients who may potentially benefit from SMI screening. These patients should have a high prevalence of severe CAD and potential benefit of revascularization, such as patients with renal failure, left ventricular dysfunction and peripheral or carotid occlusive arterial disease.
糖尿病的患病率一直在持续上升。冠状动脉疾病（CAD）是主要死因；然而，无症状心肌缺血（SMI）在糖尿病患者中更为常见。通过SMI筛查实现的CAD早期诊断可降低心血管并发症和死亡率。当前指南建议对基于高心血管风险选定的无症状糖尿病患者进行SMI筛查，若应激试验呈阳性则进行冠状动脉造影。然而，在危险因素得到最佳治疗的糖尿病患者中，系统性SMI筛查的益处尚未得到证实。SMI糖尿病患者血管重建的益处似乎仅限于严重CAD患者。需要进行前瞻性研究，以确定可能从SMI筛查中潜在获益的糖尿病患者。这些患者应具有高比例的严重CAD以及血管重建的潜在益处，例如肾衰竭、左心室功能障碍以及外周或颈动脉闭塞性动脉疾病患者。
