Valensi P, Sachs R N, Lormeau B, Taupin J M, Ouzan J, Blasco A, Nitenberg A, Metz D, Paries J, Talvard O, Leutenegger M, Attali J R
Service d'Endocrinologie-Diabétologie-Nutrition, Hôpital Jean Verdier, Bondy, France.
Diabetes Metab. 1997 Nov;23(5):409-16.
The purpose of this study was to evaluate the ability of three noninvasive techniques to detect silent myocardial ischaemia and analyse the factors associated with this condition, particularly left ventricular hypertrophy, in diabetic patients. An ECG stress test, a thallium-201 myocardial scintigraphy with dipyridamole intravenous infusion, ambulatory 48 h ECG monitoring and an echocardiographic study were performed in 92 diabetic patients without cardiac symptoms but with > or = 2 additional cardiovascular risk factors. At least one of these tests was positive in 28 patients (30.4%), suggesting silent myocardial ischaemia. Twenty-four of these patients had a coronary angiography which showed significant coronary stenosis in only 9 cases. An accurate echocardiographic tracing was obtained in 79 patients, particularly in 7 of the 9 with coronary stenosis. Left ventricular hypertrophy was detected in 34 patients, 6 of whom had coronary stenosis. In patients with left ventricular hypertrophy, the positive predictive values of myocardial scintigraphy and the ECG stress test were respectively 50% and 100%, as compared to only 33% and 11% in those without hypertrophy. In summary, coronary stenoses were found in < 10% of asymptomatic diabetic patients with > or = 2 cardiovascular risk factors, but more frequently in individuals with left ventricular hypertrophy. Thus, silent myocardial ischaemia should be searched for first in diabetic patients with hypertrophy, for which the stress test was the most accurate detection method in this study.
本研究的目的是评估三种非侵入性技术检测无症状性心肌缺血的能力，并分析与该病症相关的因素，尤其是糖尿病患者的左心室肥厚。对92例无心脏症状但有≥2种其他心血管危险因素的糖尿病患者进行了心电图负荷试验、静脉输注双嘧达莫的铊-201心肌闪烁显像、48小时动态心电图监测及超声心动图检查。这些检查中至少有一项呈阳性的患者有28例（30.4%），提示存在无症状性心肌缺血。其中24例患者进行了冠状动脉造影，仅9例显示有明显的冠状动脉狭窄。79例患者获得了准确的超声心动图描记，尤其是9例冠状动脉狭窄患者中的7例。34例患者检测出左心室肥厚，其中6例有冠状动脉狭窄。在左心室肥厚患者中，心肌闪烁显像和心电图负荷试验的阳性预测值分别为50%和100%，而在无肥厚患者中分别仅为33%和11%。总之，在有≥2种心血管危险因素的无症状糖尿病患者中，冠状动脉狭窄的发生率不到10%，但在左心室肥厚患者中更为常见。因此，对于肥厚型糖尿病患者应首先筛查无症状性心肌缺血，在本研究中负荷试验是最准确的检测方法。
