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冠動脈血管機能不全と糖尿病・糖尿病のない患者の心臓死亡率との関連
Venkatesh L Murthy1, Masanao Naya, Courtney R Foster
1Noninvasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Circulation
|August 25, 2012
まとめ
冠動脈血管拡張器の機能不全は,糖尿病患者および非糖尿病患者の心臓死亡リスクを大幅に増加させます. CADミラーのない糖尿病患者の冠動脈流量準備 (CFR) 障害は,既知のCADを有する非糖尿病患者のリスクである.
科学分野:
- 心臓病学 心臓病学
- 糖尿病学 糖尿病学
- メディカルイマージング (医学イメージング)
背景:
- 糖尿病は,しばしば冠動脈疾患 (CAD) と同等とみなされる有害な心臓疾患の危険因子として知られています.
- 冠動脈血管機能不全の早期発見は,糖尿病患者の心臓発作リスクの増加を理解するために重要です.
研究 の 目的:
- 冠動脈循環準備量 (CFR) によって評価される冠動脈血管機能不全が,糖尿病患者における心臓発作リスクの上昇を,非糖尿病患者と比較して説明するかどうかを調査する.
- 心臓発作による死亡リスクの階層化におけるCFRのインクリメンタル予後値の評価を図る.
主な方法:
- 2783人の患者 (1172人の糖尿病患者,1611人の非糖尿病患者) のポジトロン放出トモグラフィを用いた冠動脈流量準備量 (CFR) の定量化.
- 心臓発作による死亡の主なエンドポイントを決定するために,平均1.4年間の追跡調査を行った.
- CFR,糖尿病状態,心臓病死亡率との関連性,およびCFRがリスクモデルに与える付加価値を評価するための統計分析.
主要な成果:
- CFRの低下は,糖尿病患者の心臓死リスクの3.2倍,非糖尿病患者の4.9倍の増加と関連していました.
- 臨床およびイメージングリスクモデルにCFRを追加することで,両方のグループにおけるリスク差別が著しく改善されました.
- CADのない,しかしCFRが低下した糖尿病患者は,CADが知られている非糖尿病患者と同様の心臓死亡率を示しました.
結論:
- 冠動脈血管拡張器機能不全は,CFRの低下によって示され,糖尿病および非糖尿病の両方において,心臓病による死亡率の強力な独立した予測因子です.
- CFRは,重要なインクリメンタルリスクの分層化を提供しており,以前にCADが診断されていない高リスクの糖尿病患者を特定するのに特に有用です.
- CADと保存されたCFRのない糖尿病患者は,糖尿病と正常な心臓機能のない患者と比較して,非常に低い心臓死亡率を示します.
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