Screening for asymptomatic coronary artery disease in patients with type 2 diabetes mellitus

ABSTRACT Diabetes is a very frequent disease and it is estimated that its prevalence will continuously increase during the next two decades. The arteriosclerotic process in diabetic patients progresses earlier and more diffusely, and it is more accelerated in the diabetic patient than in the overall population. In diabetic subjects, acute myocardial infarction (AMI) and stroke are the leading causes of death, but the presence of arterial disease is not always detected before the development of the acute arterial event. Several times, AMI is asymptomatic or present nonspecific symptoms, and it is the initial form of presentation of coronary artery disease causing an important delay in initiating cardiovascular treatment in these patients. The purpose of this review article is to discuss how to screen and early diagnose the presence of coronary artery disease in asymptomatic diabetic patients, based on new available diagnostic resources. Currently, the most recommended technique used for screening coronary artery disease in these patients is myocardial perfusion scintigraphy or stress echocardiography because of greater sensitivity and specificity in relation to the exercise test. However, technological advances have enabled the development of new imaging diagnostic methods that are less invasive than conventional coronary angiography, and which gradually gain importance in the diagnosis of coronary artery disease as they show higher effectiveness with lower invasiveness and risk. Arch Endocrinol Metab. 2016;60(2):143-51

摘要：糖尿病是一种极为高发的疾病，据估计，未来二十年内其患病率将持续攀升。糖尿病患者的动脉粥样硬化进程（arteriosclerotic process）较普通人群更早启动、分布更广泛，且进展速度更快。在糖尿病患者中，急性心肌梗死（acute myocardial infarction, AMI）和脑卒中（stroke）是主要致死原因，但动脉粥样硬化病变往往在急性动脉事件发生前未被检出。部分患者的急性心肌梗死可无明显症状，或仅表现为非特异性症状，而这正是冠状动脉粥样硬化性心脏病（coronary artery disease）的首发表现，导致此类患者心血管治疗的启动被显著延误。本综述旨在探讨如何基于现有新型诊断技术，对无症状糖尿病患者的冠状动脉粥样硬化性心脏病进行筛查与早期诊断。目前，针对此类患者的冠状动脉粥样硬化性心脏病筛查，最推荐的技术为心肌灌注显像（myocardial perfusion scintigraphy）或负荷超声心动图（stress echocardiography），因其相较于运动负荷试验（exercise test）具有更高的灵敏度与特异度。然而，技术进步推动了一批较传统冠状动脉造影（conventional coronary angiography）创伤性更低的新型影像诊断技术的发展，这类技术凭借更高的诊断效能、更低的侵入性与风险，在冠状动脉粥样硬化性心脏病的诊断中逐渐获得重视。Arch Endocrinol Metab. 2016;60(2):143-51