Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy.
BMC Cardiovasc Disord. 2013 Nov 14;13:99. doi: 10.1186/1471-2261-13-99.
To evaluate the relevance of stress-induced decrease in left ventricular ejection fraction (LVEF) in patients with type-2 diabetes.
A total of 684 diabetic patients with available rest and post-stress gated myocardial perfusion single-photon emission computed tomography (MPS) data were enrolled. An automated algorithm was used to determine the perfusion scores using a 17-segment model. LVEF drop was considered significant if the post-stress LVEF was ≥5% below the rest value. Follow-up data were available in 587 patients that were followed for the occurrence of cardiac death, nonfatal myocardial infarction, or unstable angina requiring revascularization.
A post-stress LVEF drop ≥5% was observed in 167 (24%) patients. Patients with LVEF drop had higher summed stress score (p < 0.05), summed difference score (p < 0.001), and rest LVEF (p < 0.001) compared to patients without. Conversely, summed rest score, a measure of infarct size, was comparable between the two groups. At multivariable analysis, summed difference score and rest LVEF were independent predictors (both p < 0.001) of post-stress LVEF drop. Myocardial perfusion was abnormal in 106 (63%) patients with post-stress LVEF drop and in 296 (57%) of those without (p = 0.16). The overall event-free survival was lower in patients with post-stress LVEF drop than in those without (log rank χ2 7.7, p < 0.005). After adjusting for clinical data and MPS variables, the hazard ratio for cardiac events for post-stress LVEF drop was 1.52 (p < 0.01).
In diabetic patients stress-induced ischemia is an independent predictor of post-stress LVEF drop; however, a reduction in LVEF is detectable also in patients with normal perfusion. Finally, post-stress LVEF drop increases the risk of subsequent cardiac events in diabetic patients.
评估 2 型糖尿病患者应激导致左心室射血分数（LVEF）下降的相关性。
共纳入 684 例有静息和应激门控心肌灌注单光子发射计算机断层扫描（MPS）数据的糖尿病患者。使用自动算法根据 17 节段模型确定灌注评分。如果应激后 LVEF比静息值低 5%，则认为 LVEF 下降有意义。在 587 例可获得随访数据的患者中，观察到心脏性死亡、非致死性心肌梗死或需要血运重建的不稳定型心绞痛的发生。
167 例（24%）患者出现应激后 LVEF 下降≥5%。与无 LVEF 下降的患者相比，LVEF 下降的患者有更高的总和应激评分（p<0.05）、总和差异评分（p<0.001）和静息 LVEF（p<0.001）。相反，两组间总和静息评分（衡量梗死面积的指标）无差异。多变量分析显示，总和差异评分和静息 LVEF 是应激后 LVEF 下降的独立预测因素（均 p<0.001）。应激后 LVEF 下降的患者中有 106 例（63%）和无 LVEF 下降的患者中有 296 例（57%）存在心肌灌注异常（p=0.16）。与无应激后 LVEF 下降的患者相比，应激后 LVEF 下降的患者整体无事件生存率较低（对数秩 χ2=7.7，p<0.005）。在校正临床数据和 MPS 变量后，应激后 LVEF 下降的心脏事件风险比为 1.52（p<0.01）。
在糖尿病患者中，应激诱导的缺血是应激后 LVEF 下降的独立预测因素；然而，在灌注正常的患者中也可检测到 LVEF 下降。最后，应激后 LVEF 下降增加了糖尿病患者后续心脏事件的风险。
