Malahfji Maan, Mahmarian John J
HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS.
Methodist Debakey Cardiovasc J. 2018 Oct-Dec;14(4):266-272. doi: 10.14797/mdcj-14-4-266.
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with diabetes mellitus. Patients with diabetes have a higher prevalence of CAD and a larger magnitude of ischemia, and they are more likely to have silent myocardial ischemia and myocardial infarction. However, recent large cohort studies demonstrate that diabetic patients are not a homogenous group with similar high risk for cardiac events. In fact, more than 30% of asymptomatic diabetic patients do not have evidence of coronary atherosclerosis and have a very low annual cardiac event rate. Accordingly, there has been a recent paradigm shift as to whether the detection of subclinical coronary atherosclerosis through imaging can best guide therapeutic decision making. This review discusses the role of various cardiac imaging techniques for stratifying cardiovascular risk and optimizing therapy in asymptomatic diabetic patients.
冠状动脉疾病（CAD）是糖尿病患者发病和死亡的主要原因。糖尿病患者CAD的患病率更高，缺血程度更严重，且更易发生无症状心肌缺血和心肌梗死。然而，最近的大型队列研究表明，糖尿病患者并非是具有相似高心脏事件风险的同质群体。事实上，超过30%的无症状糖尿病患者没有冠状动脉粥样硬化的证据，且年度心脏事件发生率极低。因此，对于通过影像学检测亚临床冠状动脉粥样硬化是否能最佳指导治疗决策，最近出现了一种范式转变。本综述讨论了各种心脏成像技术在无症状糖尿病患者心血管风险分层和优化治疗中的作用。
