Al-Daydamony Mohammad M, El-Tahlawi Mohammad A, Shawky Ahmad
Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Echocardiography. 2016 Dec;33(12):1823-1827. doi: 10.1111/echo.13359. Epub 2016 Sep 28.
Coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with diabetes. Silent myocardial ischemia (SMI) is common in patients with diabetes and is associated with poorer prognosis. Myocardial performance index "Tei index" that reflects both left ventricular (LV) systolic and diastolic function. The aim of our study was to test the value of Tei index in prediction of SMI in asymptomatic patients with type 2 diabetes.
Asymptomatic patients with type 2 diabetes were included in our study. We excluded patients with known CAD, previous revascularization, low ejection fraction, or abnormal ECG from the study. All patients had undergone history taking and clinical examination, ECG, echocardiography with measuring of Tei index and Holter monitoring for detecting silent ischemia.
A total of 200 patients were recruited. We divided our patients into two groups: Group I: 64 patients with SMI, Group II: 136 patients without SMI. There was no significant difference between the two groups regarding clinical and conventional echocardiographic data. Tei index was significantly higher in patients with silent ischemia (P<.00001). Sensitivity, specificity, positive, and negative predictive values of Tei index ≥0.6 in prediction of Holter detected silent ischemia were 85.9%, 90%, 78.6%, and 88.6%, respectively. We found a significant positive correlation between Tei index and number of ischemic episodes (r=.366, P=.0029).
Measuring Tei index is helpful in predicting the presence of silent ischemia in asymptomatic patients with type 2 diabetes.
冠状动脉疾病（CAD）是糖尿病患者发病和死亡的重要原因。无症状心肌缺血（SMI）在糖尿病患者中很常见，且与较差的预后相关。心肌性能指数“Tei指数”可反映左心室（LV）的收缩和舒张功能。我们研究的目的是检验Tei指数在预测2型糖尿病无症状患者SMI中的价值。
我们的研究纳入了2型糖尿病无症状患者。我们将已知患有CAD、既往接受过血运重建、射血分数低或心电图异常的患者排除在研究之外。所有患者均接受了病史采集、临床检查、心电图、测量Tei指数的超声心动图检查以及用于检测无症状缺血的动态心电图监测。
共招募了200名患者。我们将患者分为两组：第一组：64例SMI患者，第二组：136例无SMI患者。两组在临床和传统超声心动图数据方面无显著差异。无症状缺血患者的Tei指数显著更高（P<.00001）。Tei指数≥0.6预测动态心电图检测到的无症状缺血的敏感性、特异性、阳性预测值和阴性预测值分别为85.9%、90%、78.6%和88.6%。我们发现Tei指数与缺血发作次数之间存在显著正相关（r = 0.366，P = 0.0029）。
测量Tei指数有助于预测2型糖尿病无症状患者无症状缺血的存在。
