Biondi-Zoccai Giuseppe, Pinto Annamaria, Versaci Francesco, Procaccini Enrica, Neri Giandomenico, Sesti Giorgio, Uccioli Luigi, Vetere Maurizio, Peruzzi Mariangela, Nudi Francesco
*Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; †Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy; ‡Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy; §Ostia Radiologica, Rome, Italy; ¶Department of Cardiovascular Disease, Ospedale A. Cardarelli, Campobasso, Italy; ‖Department of Cardiovascular Disease, Ospedale F. Veneziale, Isernia, Italy; **Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy; ††Diabetic Foot Unit, Tor Vergata University of Rome, Rome, Italy; and ‡‡Etisan, Rome, Italy.
J Cardiovasc Pharmacol. 2016 Aug;68(2):162-70. doi: 10.1097/FJC.0000000000000399.
Hypoglycemic agents differ in mechanism, efficacy, and profile. However, there is uncertainty on their impact on myocardial perfusion. We thus aimed to investigate whether individuals with type 2 diabetes mellitus treated with different drug classes exhibit different perfusion patterns at myocardial perfusion scintigraphy (MPS).
We queried our administrative database for patients with diabetes mellitus without prior or recent myocardial infarction. The primary objective was to compare the severity and extent of ischemia at MPS, distinguishing patients according to management strategy. A total of 7592 patients were included [2336 (31%) on diet, 3611 (48%) on metformin, 749 (10%) on sulfonylureas, 449 (6%) on metformin plus sulfonylureas, 447 (6%) on metformin plus insulin]. Unadjusted analyses and analyses adjusting for baseline features suggested that sulfonylureas alone or in combination were associated with more severe ischemia than nonsulfonylurea regimens (P < 0.05), whereas combination regimens including metformin were associated with more extensive myocardial ischemia than the other regimens (P < 0.05 for both). However, no significant difference disfavoring either metformin or sulfonylurea regimens persisted after multivariable adjustment for baseline, stress, and angiographic characteristics (all P > 0.05).
Several significant differences in baseline, stress, and scintigraphic features appear evident in patients with diabetes mellitus receiving different hypoglycemic agents or regimens.
降糖药物在作用机制、疗效和特点方面存在差异。然而，它们对心肌灌注的影响尚不确定。因此，我们旨在研究接受不同药物治疗的2型糖尿病患者在心肌灌注显像（MPS）时是否表现出不同的灌注模式。
我们在管理数据库中查询无既往或近期心肌梗死的糖尿病患者。主要目的是比较MPS时缺血的严重程度和范围，根据治疗策略对患者进行区分。共纳入7592例患者[2336例（31%）接受饮食治疗，3611例（48%）接受二甲双胍治疗，749例（10%）接受磺脲类药物治疗，449例（6%）接受二甲双胍加磺脲类药物治疗，447例（6%）接受二甲双胍加胰岛素治疗]。未经调整的分析以及对基线特征进行调整后的分析表明，单独使用磺脲类药物或联合使用磺脲类药物比非磺脲类治疗方案与更严重的缺血相关（P<0.05），而包括二甲双胍的联合治疗方案比其他治疗方案与更广泛的心肌缺血相关（两者P<0.05）。然而，在对基线、应激和血管造影特征进行多变量调整后，支持二甲双胍或磺脲类治疗方案的显著差异均未持续存在（所有P>0.05）。
接受不同降糖药物或治疗方案的糖尿病患者在基线、应激和显像特征方面存在一些显著差异。
