Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC.
Diabetes Care. 2019 Jul;42(7):1290-1296. doi: 10.2337/dc18-2266. Epub 2019 Apr 22.
To determine the prevalence and prognostic significance of unrecognized myocardial infarction (MI) by delayed-enhancement MRI (DE-MRI) in asymptomatic patients with diabetes.
In this prospective, two-center study of asymptomatic patients without known cardiac disease ( = 120), two prespecified cohorts underwent a research MRI: ) a high-risk group with type 1 diabetes and chronic renal insufficiency ( = 50) and ) an average-risk group with type 2 diabetes ( = 70). The primary end point was a composite of all-cause mortality and clinical MI.
Overall, the prevalence of unrecognized MI was 19% by DE-MRI (28% high-risk group and 13% average-risk group) and 5% by electrocardiography. During up to 5 years of follow-up with a total of 460 patient-years of follow-up, the rate of death/MI was markedly higher in patients with diabetes with (vs. without) unrecognized MI (all 44% vs. 7%, high-risk group 43% vs. 6%, and average-risk group 44% vs. 8%; all < 0.01). After adjustment for Framingham risk score, left ventricular ejection fraction, and diabetes type, the presence of unrecognized MI by DE-MRI conferred an eightfold increase in risk of death/MI (95% CI 3.0-21.1, < 0.0001). Addition of unrecognized MI to clinical indices significantly improved model discrimination for adverse events (integrated discrimination improvement = 0.156, = 0.001).
Unrecognized MI is prevalent in asymptomatic patients with diabetes without a history of cardiac disease and confers a markedly increased risk of death and clinical MI.
通过延迟增强 MRI（DE-MRI）确定无症状糖尿病患者中未被识别的心肌梗死（MI）的患病率和预后意义。
在这项针对无症状、无已知心脏病的患者（n=120）的前瞻性、双中心研究中，两个预设队列接受了研究性 MRI 检查：）高危组，包括 1 型糖尿病和慢性肾功能不全患者（n=50）和）平均风险组，包括 2 型糖尿病患者（n=70）。主要终点是全因死亡率和临床 MI 的复合终点。
总体而言，DE-MRI 检测到的未被识别的 MI 的患病率为 19%（高危组为 28%，平均风险组为 13%），而心电图检测到的患病率为 5%。在长达 5 年的随访期间，共有 460 患者-年的随访时间，糖尿病患者中有无未被识别的 MI 的死亡率/MI 发生率明显更高（所有患者 44% vs. 7%，高危组 43% vs. 6%，平均风险组 44% vs. 8%；均 < 0.01）。在校正了 Framingham 风险评分、左心室射血分数和糖尿病类型后，DE-MRI 检测到的未被识别的 MI 使死亡/MI 的风险增加了 8 倍（95%CI 3.0-21.1， < 0.0001）。将未被识别的 MI 加入临床指标可显著提高不良事件的模型区分度（综合判别改善=0.156，=0.001）。
无症状、无心脏病史的糖尿病患者中，未被识别的 MI 很常见，可显著增加死亡和临床 MI 的风险。
