Department of Diagnostic Radiology, The University of Hong Kong, Room 406, Block K, 102 Pokfulam Road, Hong Kong SAR, China.
Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Cardiovasc Diabetol. 2020 Mar 31;19(1):42. doi: 10.1186/s12933-020-01019-2.
Stress cardiovascular magnetic resonance (CMR) to screen for silent myocardial ischaemia in asymptomatic high risk patients with type 2 diabetes mellitus (DM) has never been performed, and its effectiveness is unknown. Our aim was to determine the feasibility of a screening programme using stress CMR by obtaining preliminary data on the prevalence of silent ischaemia caused by obstructive coronary artery disease (CAD) and quantify myocardial perfusion in asymptomatic high risk patients with type 2 diabetes.
In this prospective cohort study, we recruited 63 asymptomatic DM patients (mean age 66 years ± 4.4 years; 77.8% male); with Framingham risk score ≥ 20% from 3 sites from June 2017 to August 2018. Normal volunteers were recruited to determine normal global myocardial perfusion reserve index (MPRI). Adenosine stress CMR and global MPRI was performed and measured in all subjects. Positive stress CMR cases were referred for catheter coronary angiography (CCA) with/without fractional flow reserve (FFR) measurements. Positive CCA was defined as an FFR ≤ 0.8 or coronary narrowing ≥ 70%. Patients were followed up for major adverse cardiovascular events. Prevalence is presented as patient numbers and percentage. Mann-Whitney U test was used to compare global MPRI between patients and normal volunteers.
13 patients had positive stress CMR with positive CCA (20.6% of patient population), while 9 patients with positive stress CMR examinations had a negative CCA. 5 patients (7.9%) had infarcts detected of which 2 patients had no stress perfusion defects. 12 patients had coronary artery stents inserted, whilst 1 patient declined stent placement. DM patients had lower global MPRI than normal volunteers (n = 7) (1.43 ± 0.27 vs 1.83 ± 0.31 respectively; p < 0.01). After a median follow-up of 653 days, there was no death, heart failure, acute coronary syndrome hospitalisation or stroke.
20.6% of asymptomatic DM patients (with Framingham risk ≥ 20%) had silent obstructive CAD. Furthermore, asymptomatic patients have reduced global MPRI than normal volunteers.
ClinicalTrials.gov Registration Number: NCT03263728 on 28th August 2017; https://clinicaltrials.gov/ct2/show/NCT03263728.
从未对无症状的高危 2 型糖尿病患者进行过压力心血管磁共振（CMR）筛查无症状性心肌缺血，其有效性尚不清楚。我们的目的是通过获得关于由阻塞性冠状动脉疾病（CAD）引起的无症状性缺血的患病率的初步数据，并量化无症状的高危 2 型糖尿病患者的心肌灌注来确定使用压力 CMR 的筛查计划的可行性。
在这项前瞻性队列研究中，我们招募了来自 2017 年 6 月至 2018 年 8 月 3 个地点的 63 名无症状 DM 患者（平均年龄 66±4.4 岁；77.8%男性）；Framingham 风险评分≥20%。招募正常志愿者以确定正常的整体心肌灌注储备指数（MPRI）。对所有患者进行腺苷压力 CMR 和整体 MPRI 检查。阳性压力 CMR 病例经导管冠状动脉造影（CCA）检查，有/无血流储备分数（FFR）测量。阳性 CCA 的定义为 FFR≤0.8 或冠状动脉狭窄≥70%。对患者进行主要不良心血管事件随访。患病率以患者人数和百分比表示。使用 Mann-Whitney U 检验比较患者和正常志愿者之间的整体 MPRI。
13 名患者的压力 CMR 检查呈阳性且 CCA 阳性（占患者人群的 20.6%），而 9 名压力 CMR 检查阳性的患者 CCA 阴性。5 名患者（7.9%）检测到梗死，其中 2 名患者无压力灌注缺陷。12 名患者植入了冠状动脉支架，而 1 名患者拒绝支架植入。DM 患者的整体 MPRI 低于正常志愿者（n=7）（分别为 1.43±0.27 和 1.83±0.31；p<0.01）。中位随访 653 天后，无死亡、心力衰竭、急性冠状动脉综合征住院或中风。
无症状 DM 患者（Framingham 风险≥20%）中有 20.6%存在无症状性阻塞性 CAD。此外，无症状患者的整体 MPRI 低于正常志愿者。
ClinicalTrials.gov 注册号：NCT03263728，2017 年 8 月 28 日；https://clinicaltrials.gov/ct2/show/NCT03263728。
