Mitevska Irena Peovska, Baneva Natalija, Bosevski Marijan, Kostovska Elizabeta Srbinovska
University Cardiology Clinic Nuclear Cardiology Dept University "St Cyril and Methodius" Medical Faculty, Skopje, Macedonia.
Nucl Med Rev Cent East Eur. 2017;20(1):3-9. doi: 10.5603/NMR.a2016.0039.
The aim of the study was to evaluate whether there is any association between myocardial ischemia, common risk factors and carotid artery ultrasound parameters in asymptomatic type 2 diabetic (DMT2) patients.
60 asymptomatic DMT2 patients (pts) without known coronary artery disease (CAD) underwent one day rest Dypiridamole stress Tc-99m sestamibi single photon emission computed tomography myocardial perfusion scintigraphy (MPS). We used 17 segment models for perfusion analysis with the assessment of perfusion scores. Patients were studied for age, sex, hypertension, hyperlipidemia, hs-CRP, smoking, obesity and family history of cardiac disease. Color Ultrasound examination of carotid arteries was performed in all patients.
51 patients (pts) had hypertension, 48 pts had hyperlipidemia, 15 were smokers, 6 pts had BMI > 30 kg/m2 and 26 patients had positive family history for CAD. 18 (31%) patients had myocardial ischemia. Mild ischemia was found in 6 pts, moderate in 7 patients and severe ischemia in 5 patients. Carotid IMT was increased in 34 pts and 15 pts had carotid plaques. Mean c-IMT value in patients with normal MPS results was 0.7 ± 0.1; in moderate ischemia 0.9 ± 0.1 and in pts severe ischemia 1.0 ± 0.2. Multivariate analysis showed obesity, low HDL and increased diastolic blood pressure predictors of increased c-IMT. Increased pulse pressure (PP), age and non-HDL cholesterol were predictors for presence of carotid plaques. Multivariable analysis for prediction of stress induced ischemia showed OR 2.9 (95% CI 2.1-5.1) for male gender, OR 3.1 for systolic blood pressure (95% CI 1.9-3.8) and OR 2.8 for LDL cholesterol (95% CI 1.7-3.6).
Our study has shown high prevalence of traditional risk factors and silent myocardial ischemia in type 2 diabetic patients, with the importance of SPECT imaging in selected diabetes type 2 patients. The study highlights the importance of screening for carotid atherosclerosis, which may be useful to identify diabetic patients at higher risk for coronary artery disease..
本研究旨在评估无症状2型糖尿病（DMT2）患者的心肌缺血、常见危险因素与颈动脉超声参数之间是否存在关联。
60例无已知冠状动脉疾病（CAD）的无症状DMT2患者接受了一日休息的双嘧达莫负荷Tc-99m司他比单光子发射计算机断层扫描心肌灌注显像（MPS）。我们使用17节段模型进行灌注分析并评估灌注评分。对患者进行年龄、性别、高血压、高脂血症、高敏C反应蛋白、吸烟、肥胖及心脏病家族史的研究。所有患者均接受颈动脉彩色超声检查。
51例患者患有高血压，48例患有高脂血症，15例吸烟，6例体重指数（BMI）>30kg/m²，26例有CAD家族史阳性。18例（31%）患者存在心肌缺血。6例为轻度缺血，7例为中度缺血，5例为重度缺血。34例患者颈动脉内膜中层厚度（IMT）增加，15例有颈动脉斑块。MPS结果正常的患者平均c-IMT值为0.7±0.1；中度缺血患者为0.9±0.1，重度缺血患者为1.0±0.2。多变量分析显示肥胖、低高密度脂蛋白（HDL）及舒张压升高是c-IMT增加的预测因素。脉压（PP）升高、年龄及非HDL胆固醇是颈动脉斑块存在的预测因素。应激诱导缺血预测的多变量分析显示，男性的比值比（OR）为2.9（95%可信区间[CI]2.1 - 5.1），收缩压的OR为3.1（95%CI 1.9 - 3.8），低密度脂蛋白（LDL）胆固醇的OR为2.8（95%CI 1.7 - 3.6）。
我们的研究表明2型糖尿病患者中传统危险因素和无症状心肌缺血的患病率较高，SPECT成像在部分2型糖尿病患者中具有重要意义。该研究强调了筛查颈动脉粥样硬化的重要性，这可能有助于识别冠状动脉疾病高危的糖尿病患者。
