Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease
Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease
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DOI：
10.1186/1475-2840-12-121
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发表时间：
2013-08-27
影响因子：
9.3
通讯作者：
Daida, Hiroyuki
中科院分区：
文献类型：
--
作者：
Kawata, Takayuki;Daimon, Masao;Daida, Hiroyuki
背景：无症状糖尿病患者的心血管危险分层是一个重要的临床难题。我们的目的是验证无创经胸超声心动图评估冠状动脉血流储备(CFR)可以预测这些患者预后的假设。方法：从2002年2月到2005年1月，我们评估了连续135例无症状的2型糖尿病患者(男性74例，平均年龄63+/-9岁)，无冠状动脉病史。应用三磷酸腺苷(0.14 mg/kg/min)负荷多普勒超声心动图评价左前降支的血流动力学。同时排除有冠状动脉左前降支明显狭窄的患者。结果：共纳入患者111例(男性60例，平均年龄+/-9岁)。在79个月的中位随访期内，发生了20起事件(5例死亡，7例急性冠脉综合征，8例冠状动脉血运重建)。CFR预测事件的最佳界值为2.5(受试者-操作特征曲线下面积=0.65)。多因素分析显示，男性(p<；0.05)和CFR<；2.5(p<；0.01)是独立的预后指标。Kaplan-Mayer分析显示CFR=2.5的患者的事件发生率显著高于CFR=2.5的患者(log-lank，p<；0.01)。结论：经胸多普勒超声心动图获得的CFR可为无明显冠状动脉病变的2型糖尿病患者提供独立的预后信息。CFR<；2.5的患者的长期结果更差。
Background: Cardiovascular risk stratification of asymptomatic diabetic patients is important and remains a difficult clinical problem. Our aim was to test the hypothesis that coronary flow reserve (CFR) assessed by noninvasive transthoracic Doppler echocardiography predicts prognosis in those patients.Methods: From February 2002 to January 2005, we evaluated 135 consecutive asymptomatic patients (74 male; mean age, 63 +/- 9 years) with type 2 diabetes without a history of coronary artery disease. Adenosine triphosphate (0.14 mg/kg/min) stress Doppler echocardiography was performed to evaluate CFR of the left anterior descending artery. Patients with a CFR < 2.0 were also excluded based on the suspicion of significant coronary artery stenosis in the left anterior descending artery.Results: There were 111 patients (60 male; mean age, 64 +/- 9 years) enrolled. During a median follow-up of 79 months, 20 events (5 deaths, 7 acute coronary syndromes, 8 coronary revascularizations) occurred. The optimal cut-off value of CFR to predict events was 2.5 (area under the receiver-operating characteristic curve = 0.65). Multivariate analysis showed that the independent prognostic indicators were male gender (p < 0.05) and a CFR < 2.5 (p < 0.01). Kaplan-Mayer analysis revealed that the event rate was significantly higher (log-lank, p < 0.01) in patients with CFR< 2.5 than in those with CFR = 2.5.Conclusions: CFR obtained by transthoracic Doppler echocardiography provides independent prognostic information in asymptomatic patients with type 2 diabetes without overt coronary artery disease. Patients with CFR < 2.5 had a worse long-term outcome.