Unit of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Avenue du 14 Juillet. 93140, Bondy, France.
Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France.
Cardiovasc Diabetol. 2023 Feb 15;22(1):33. doi: 10.1186/s12933-023-01760-4.
The 2019 guidelines for cardiovascular risk stratification by the European Society of Cardiology and European Association for the Study of Diabetes (ESC-EASD) suggested screening for silent coronary disease in very high risk patients with severe target organ damage (TOD) (i.e. peripheral occlusive arterial disease or severe nephropathy) or high coronary artery calcium (CAC) score. This study aimed to test the validity of this strategy.
In this retrospective study, we included 385 asymptomatic patients with diabetes and no history of coronary disease but with TOD or ≥ 3 risk factors in addition to diabetes. CAC score was measured using computed tomography scan and a stress myocardial scintigraphy was performed to detect silent myocardial ischemia (SMI), with subsequent coronary angiography in those with SMI. Various strategies to select patients to be screened for SMI were tested.
CAC score was ≥ 100 Agatston units (AU) in 175 patients (45.5%). SMI was present in 39 patients (10.1%) and among the 30 patients who underwent angiography, 15 had coronary stenoses and 12 had a revascularization procedure. The most effective strategy consisted in performing myocardial scintigraphy in the 146 patients with severe TOD and, among the 239 other patients without severe TOD, in those with CAC ≥ 100 AU: this strategy provided 82% sensitivity for SMI diagnosis, and identified all the patients with stenoses.
The ESC-EASD guidelines suggesting SMI screening in asymptomatic patients with very high risk assessed by severe TOD or high CAC score appears effective and could identify all the patients with stenoses eligible for revascularization.
欧洲心脏病学会（ESC）和欧洲糖尿病研究协会（EASD）2019 年心血管风险分层指南建议对严重靶器官损伤（TOD）（即外周动脉闭塞性疾病或严重肾病）或高冠状动脉钙（CAC）评分的极高危患者进行无症状性冠心病筛查。本研究旨在检验该策略的有效性。
在这项回顾性研究中，我们纳入了 385 名无症状的糖尿病患者，他们没有冠心病病史，但除了糖尿病外，还有 TOD 或≥3 个危险因素。通过计算机断层扫描测量 CAC 评分，并进行应激心肌闪烁显像以检测无症状性心肌缺血（SMI），对有 SMI 的患者进行随后的冠状动脉造影。测试了各种选择患者进行 SMI 筛查的策略。
175 名患者（45.5%）的 CAC 评分≥100 个 Agatston 单位。39 名患者（10.1%）存在 SMI，在接受冠状动脉造影的 30 名患者中，15 名有冠状动脉狭窄，12 名接受了血运重建。最有效的策略是对 146 名严重 TOD 的患者进行心肌闪烁显像，而对于 239 名没有严重 TOD 的其他患者，在 CAC≥100 AU 的患者中进行心肌闪烁显像：该策略对 SMI 的诊断有 82%的敏感性，并确定了所有有狭窄的患者。
ESC-EASD 指南建议对严重 TOD 或高 CAC 评分评估的极高危无症状患者进行 SMI 筛查似乎有效，可以确定所有适合血运重建的狭窄患者。
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