Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Radiology. 2012 Mar;262(3):807-15. doi: 10.1148/radiol.11110967. Epub 2012 Jan 24.
To investigate whether the presence of myocardial infarction (MI) detected with late gadolinium-enhanced magnetic resonance (MR) imaging is an independent predictor of major adverse cardiac events (MACEs) in patients with impaired fasting glucose (IFG) and those with overt diabetes mellitus (DM).
Institutional review board approval was obtained for this study, and all subjects provided written informed consent. Late gadolinium-enhanced and cine MR imaging were performed in 190 patients with IFG and 160 patients with DM without known previous MI to evaluate the presence and extent of late gadolinium enhancement as well as global and regional left ventricular function. MACEs were defined as cardiac death, MI, unstable angina, heart failure, and ventricular arrhythmia. The Cox proportional hazards model was used to investigate the relationship between clinical and MR imaging variables and MACEs.
Follow-up information was obtained in 181 of the 190 patients with IFG (95%) and 151 of the 160 patients with DM (94%). MACEs were observed in 15 of the 181 patients with IFG (8.3%) and 24 of the 151 with DM (15.9%). Late gadolinium enhancement was an independent predictor for MACE in both the IFG group (adjusted hazard ratio, 5.186; P = .003) and DM group (adjusted hazard ratio, 3.229; P = .015). MACE-free survival was significantly higher in patients with IFG than in those with DM (P = .019, log-rank test). However, the MACE-free survival curve for patients with IFG and late gadolinium enhancement was similar to that for patients with DM and late gadolinium enhancement (P = .735).
The presence of MI detected with late gadolinium-enhanced MR imaging is the strongest multivariable predictor of adverse cardiac events in patients with IFG. Late gadolinium-enhanced MR imaging may help identify a subpopulation of subjects in the prediabetic stage who may benefit from more intensive treatments.
研究在空腹血糖受损（IFG）和显性糖尿病（DM）患者中，使用钆延迟增强磁共振成像（MR）检测到的心肌梗死（MI）是否为主要不良心脏事件（MACE）的独立预测因子。
本研究获得了机构审查委员会的批准，所有患者均提供了书面知情同意书。对 190 例 IFG 患者和 160 例 DM 患者进行了钆延迟增强和电影 MR 成像，以评估迟钆增强的存在和程度，以及整体和局部左心室功能。MACE 定义为心脏死亡、MI、不稳定型心绞痛、心力衰竭和室性心律失常。采用 Cox 比例风险模型研究临床和 MR 成像变量与 MACE 的关系。
190 例 IFG 患者中有 181 例（95%）和 160 例 DM 患者中有 151 例（94%）获得了随访信息。在 181 例 IFG 患者中有 15 例（8.3%）和 151 例 DM 患者中有 24 例（15.9%）发生 MACE。在 IFG 组（调整后的危险比，5.186；P =.003）和 DM 组（调整后的危险比，3.229；P =.015），钆延迟增强均为 MACE 的独立预测因子。IFG 患者的 MACE 无事件生存率明显高于 DM 患者（P =.019，对数秩检验）。然而，IFG 患者和 DM 患者的钆延迟增强的 MACE 无事件生存率曲线相似（P =.735）。
用钆延迟增强 MR 成像检测到的 MI 是 IFG 患者不良心脏事件的最强多变量预测因子。钆延迟增强 MR 成像可能有助于识别糖尿病前期患者中的亚人群，这些患者可能受益于更强化的治疗。
