Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2015 Aug;16(8):863-70. doi: 10.1093/ehjci/jev003. Epub 2015 Feb 13.
The study aims (i) to evaluate changes in myocardial ischaemia on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) after 2 years in a cohort of high-risk patients with diabetes without cardiac symptoms or known coronary artery disease (CAD) and (ii) to assess the value of baseline computed tomography coronary angiography (CTA)-derived coronary atherosclerosis parameters to predict changes in myocardial ischaemia.
The population consisted of 100 high-risk patients with diabetes without cardiac symptoms referred for cardiovascular risk stratification. All patients underwent coronary artery calcium (CAC) scoring, CTA, and SPECT MPI. After 2 years of follow-up, SPECT MPI was repeated to evaluate potential progression of ischaemia.In total, 20% of patients presented with ischaemia at baseline. Of these 20 patients, 7 (35%) still had ischaemia at follow-up, whereas 13 (65%) showed resolution and 4 (20%) showed progression of ischaemia at follow-up. Of the 80 patients without ischaemia at baseline, 65 (81%) had a normal MPI at follow-up and 15 patients (19%) presented with new ischaemia. There were no significant differences in the CAC score or the extent, severity, and composition of CAD on CTA between patients with and without ischaemia at baseline. Similarly, no differences could be demonstrated between patients with and without ischaemia at follow-up or between patients with and without progression of ischaemia.
The rate of progression of ischaemia in high-risk patients with diabetes without cardiac symptoms is limited. Few patients presented with new ischaemia, whereas some patients showed resolution of ischaemia. Atherosclerosis parameters on CTA were not predictive of new-onset ischaemia or progression of ischaemia.
本研究旨在：(i)评估无心脏症状或已知冠状动脉疾病（CAD）的高危糖尿病患者队列中，经过 2 年的单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）后心肌缺血的变化；(ii)评估基线计算机断层扫描冠状动脉造影（CTA）衍生的冠状动脉粥样硬化参数预测心肌缺血变化的价值。
该人群由 100 名无心脏症状的高危糖尿病患者组成，这些患者因心血管风险分层而接受检查。所有患者均接受冠状动脉钙（CAC）评分、CTA 和 SPECT MPI 检查。2 年后进行 SPECT MPI 复查，以评估缺血的潜在进展。总共有 20%的患者在基线时存在缺血。在这 20 名患者中，7 名（35%）在随访时仍存在缺血，而 13 名（65%）显示缺血缓解，4 名（20%）显示缺血进展。在基线时无缺血的 80 名患者中，65 名（81%）在随访时 MPI 正常，15 名（19%）出现新的缺血。基线时存在和不存在缺血的患者之间的 CAC 评分或 CTA 上 CAD 的范围、严重程度和组成均无显著差异。同样，在随访时存在和不存在缺血的患者之间，或在缺血进展和无进展的患者之间，也未观察到差异。
高危糖尿病患者无心脏症状时，缺血进展的发生率有限。少数患者出现新的缺血，而一些患者显示缺血缓解。CTA 上的动脉粥样硬化参数不能预测新发缺血或缺血进展。
