Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study
Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study
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DOI：
10.2337/diacare.27.8.1954
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发表时间：
2004-08-01
期刊：
影响因子：
16.2
通讯作者：
Iskandrian, AE
中科院分区：
文献类型：
--
作者：
Wackers, FJT;Young, LH;Iskandrian, AE
目的：评估无症状2型糖尿病患者无症状性心肌缺血的患病率和临床预测因素，并检验当前美国糖尿病协会筛查指南的有效性。研究设计和方法：在无症状糖尿病（DIAD）的缺血检测研究中，1123例年龄50-75岁，无已知或疑似冠状动脉疾病的2型糖尿病患者被随机分配到压力测试和5年临床随访或仅随访。采用腺苷技术-99m sestamibi单光子发射计算机断层心肌灌注显像评估522例随机接受应激试验的患者的缺血发生率。结果：共有113例（22%）患者无症状缺血，其中83例局部心肌灌注异常，30例灌注正常但有其他异常（即腺苷诱导的st段抑制、心室扩张或静息性心室功能障碍）。33例出现中重度灌注缺损。异常检测的最强预测因子是异常Valsalva（比值比[OR] 5.6）、配偶性别（比值比[OR] 2.5）和糖尿病病程（比值比[OR] 5.2）。其他传统的心脏危险因素或炎症和血栓前期市场不具有预测性。灌注正常的缺血性腺苷诱导的st段抑制（n = 21）与女性相关（OR 3.4）。仅选择符合美国糖尿病协会指南的患者将无法识别41%的无症状缺血患者。结论：在2型糖尿病无症状患者中，无症状心肌缺血发生率大于1例。传统的和新出现的心脏危险因素与异常应激测试无关，尽管心脏自主神经功能障碍是缺血的有力预测因子。
OBJECTIVE - To assess the prevalence and clinical predictors of silent myocardial ischemia in asymptomatic patients with type 2 diabetes and to test the effectiveness of current American Diabetes Association screening guidelines.RESEARCH DESIGN AND METHODS - In the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study, 1,123 patients With type 2 diabetes, aged 50-75 years, with no known or suspected coronary artery disease, were randomly assigned to either stress testing and 5-year clinical follow-up or to follow-up only. The prevalence of ischemia in 522 patients randomized to stress testing was assessed by adenosine technetium-99m sestamibi single-photon emission-computed tomography myocardial perfusion imaging.RESULTS - A total of 113 patients (22%) had silent ischemia, including 83 with regional myocardial perfusion abnormalities and 30 with normal perfusion but other abnormalities (i.e., adenosine-induced ST-segment depression, ventricular dilation, or rest ventricular dysfunction). Moderate or large perfusion defects were present in 33 patients. The Strongest predictors for abnormal tests were abnormal Valsalva (odds ratio [OR] 5.6), mate sex (2.5), and diabetes duration (5.2). Other traditional cardiac risk factors or inflammatory and prothrombotic markets were not predictive. Ischemic adenosine-induced ST-segment depression with normal perfusion (n = 21) was associated with women (OR 3.4). Selecting only patients who met American Diabetes Association guidelines would have failed to identify 41% of patients with silent ischemia.CONCLUSIONS - Silent myocardial ischemia occurs in greater than one in live asymptomatic patients with type 2 diabetes. Traditional and emerging cardiac risk factors were not associated with abnormal stress tests, although cardiac autonomic dysfunction was a strong predictor of ischemia.