Departments of Cardiology Nuclear Medicine, University Hospital, Petersgraben 4, Basel, Switzerland.
Eur J Endocrinol. 2011 Dec;165(6):945-51. doi: 10.1530/EJE-11-0687. Epub 2011 Sep 8.
It is not clear whether diabetes reduces systolic left ventricular function (left ventricular ejection fraction, LVEF) irrespective of coronary artery disease (CAD). The aim of this study was to compare the LVEF between diabetic and non-diabetic patients with respect to the extent of CAD.
Consecutive patients undergoing stress myocardial perfusion SPECT (MPS) were evaluated. MPS was interpreted using a 20-segment model with a five-point scale to define summed stress score (SSS), summed rest score, and summed difference score. LVEF was measured by gated SPECT and then compared with respect to diabetic status and SSS categories. Of 2635 patients, data of 2400 was available. Of these, 24% were diabetic, mean age was 64±11y, and 31% were female. Diabetics had a significantly lower LVEF compared with non-diabetics regardless of the extent of CAD: 53±13 and 55±13% respectively (P=0.001). Diabetics and non-diabetics did not differ significantly in the distribution of SSS categories. Diabetes was an independent predictor of decreased LVEF (odds ratio 1.6, 95% confidence interval 1.2-2.0; P<0.001).
Diabetics had a lower LVEF than non-diabetics. This difference could be demonstrated regardless of CAD extent and might in part explain their generally worse cardiac survival compared with non-diabetics on an epidemiological level. In addition, this finding points to discussed mechanisms other than CAD lowering LVEF in diabetics.
目前尚不清楚糖尿病是否会降低收缩期左心室功能（左心室射血分数，LVEF），而不论是否存在冠状动脉疾病（CAD）。本研究的目的是比较糖尿病和非糖尿病患者在 CAD 严重程度方面的 LVEF。
连续评估接受应激心肌灌注 SPECT（MPS）的患者。使用 20 节段模型和五分制来解释 MPS，以定义总和应激评分（SSS）、总和静息评分和总和差评分。通过门控 SPECT 测量 LVEF，并根据糖尿病状态和 SSS 类别进行比较。在 2635 例患者中，有 2400 例的数据可用。其中，24%为糖尿病患者，平均年龄为 64±11 岁，31%为女性。无论 CAD 程度如何，糖尿病患者的 LVEF 均明显低于非糖尿病患者：分别为 53±13%和 55±13%（P=0.001）。糖尿病患者和非糖尿病患者在 SSS 类别分布上无显著差异。糖尿病是 LVEF 降低的独立预测因素（比值比 1.6，95%置信区间 1.2-2.0；P<0.001）。
与非糖尿病患者相比，糖尿病患者的 LVEF 较低。这种差异可以在不论 CAD 严重程度的情况下得到证明，并且可能部分解释了在流行病学水平上，糖尿病患者的心脏总体生存率普遍低于非糖尿病患者。此外，这一发现指出了在糖尿病患者中除 CAD 降低 LVEF 之外的讨论机制。
