De Keyzer Eva, Kerkhove Dirk, Van Camp Guy, De Sutter Johan, Achtergael Wim, Keymeulen Bart, Weytjens Caroline
Department of Internal Medicine, Universitair Ziekenhuis Brussel, Brussels Free University-Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Acta Cardiol. 2011 Dec;66(6):715-20. doi: 10.1080/ac.66.6.2136954.
Despite the association of diabetes mellitus type 2 (DM2) with silent myocardial ischaemia (SMI) and a high prevalence of death due to coronary artery disease (CAD), screening for CAD in patients with DM2 remains controversial because of a lack of proof that it improves cardiac outcome. The aim of this study was to improve the diagnostic yield of the exercise stress test (EST) by introducing recently published life expectancy tables in selecting DM2 patients for coronary screening.
359 patients with DM2 without history or symptoms of CAD were included to perform an EST after a clinical history and brief physical examination. Cardiovascular risk factor profiling was completed with blood and urine analysis. A lower heart rate was defined as bradycardia (heart rate less than 60 bpm), a higher blood pressure as a systolic blood pressure at rest of 130 mmHg of more.
The prevalence of SMI was 14.5% (n = 52). The average number of additional cardiovascular risk factors per subject was 4. Multivariate logistic regression yields 4 significant predictors: (i) heart rate at rest (P= 0.015), (ii) a family history of cardiovascular disease (P = 0.017), (iii) systolic blood pressure at rest (P = 0.019), and, (iv) an LDL-c of 80 mg/dL or more (P = 0.021).
Known risk factors for myocardial ischaemia were identified as significantly influencing the prevalence of SMI. No improvement in diagnostic yield could be identified by selecting the screening population using predicted life expectancy tables.
尽管2型糖尿病（DM2）与无症状心肌缺血（SMI）相关，且因冠状动脉疾病（CAD）导致的死亡患病率较高，但由于缺乏证据表明对DM2患者进行CAD筛查能改善心脏预后，因此对DM2患者进行CAD筛查仍存在争议。本研究的目的是通过引入最近发表的预期寿命表来选择DM2患者进行冠状动脉筛查，以提高运动应激试验（EST）的诊断率。
纳入359例无CAD病史或症状的DM2患者，在进行临床病史和简要体格检查后进行EST。通过血液和尿液分析完成心血管危险因素分析。心率较低定义为心动过缓（心率低于60次/分钟），血压较高定义为静息收缩压130 mmHg及以上。
SMI的患病率为14.5%（n = 52）。每位受试者平均额外的心血管危险因素数量为4个。多因素逻辑回归得出4个显著预测因素：（i）静息心率（P = 0.015），（ii）心血管疾病家族史（P = 0.017），（iii）静息收缩压（P = 0.019），以及（iv）低密度脂蛋白胆固醇（LDL-c）≥80 mg/dL（P = 0.021）。
已确定已知的心肌缺血危险因素对SMI的患病率有显著影响。通过使用预测寿命表选择筛查人群，未发现诊断率有提高。
