Background

Screening for silent coronary artery disease in asymptomatic patients with diabetes mellitus (DM) is challenging and controversial. In this context, it seems crucial to identify early markers of coronary artery disease.

Methods

The aim of this study was to investigate the incremental value of resting left ventricular (LV) global longitudinal strain (GLS) for the prediction of positive results on stress (exercise or dobutamine) transthoracic echocardiography in 273 consecutive asymptomatic high-risk patients with DM. Positive results on stress transthoracic echocardiography were defined as stress-induced LV wall motion abnormalities (new or worsening preexisting abnormalities).

Results

Compared with patients with negative stress results, those with positive stress results (n = 28 [10%]) more frequently had cardiovascular risk factors, complications of DM, vascular disease, moderate and severe calcification of the aortic valve and mitral annulus, and worse resting LV GLS (−16.7 ± 2.9% vs −19.0 ± 1.9%, P < .001). On multivariable logistic regression analysis, DM duration > 10 years, diabetic retinopathy, LV hypertrophy, and impaired LV GLS (odds ratio, 1.39 [95% CI, 1.14-1.70] per percentage increase; odds ratio, 5.16 [95% CI, 1.96-13.59] for LV GLS worse than −18%) were independently associated with positive results on stress transthoracic echocardiography. The area under the curve to predict positive results was 0.74 for LV GLS with a cutoff of −18.0% (sensitivity 68%, specificity 78%). The area under the curve of the multivariable model to predict test results was improved by the addition of LV GLS (P < .001), with a bias-corrected area under the curve after bootstrapping of 0.842 [95% CI, 0.753-0.893].

Conclusions

The present findings show that resting LV GLS is associated with the presence of silent ischemia and could be useful to better identify asymptomatic patients with DM who might benefit from coronary artery disease screening.

中文翻译：

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静息左心室整体纵向应变以识别无症状糖尿病患者的无症状心肌缺血

背景

在无症状糖尿病 (DM) 患者中筛查无症状冠状动脉疾病具有挑战性和争议性。在这种情况下，识别冠状动脉疾病的早期标志物似乎至关重要。

方法

本研究的目的是研究静息左心室 (LV) 整体纵向应变 (GLS) 对 273 名连续无症状高危 DM 患者的压力（运动或多巴酚丁胺）经胸超声心动图阳性结果预测的增量价值。压力经胸超声心动图的阳性结果被定义为压力引起的 LV 室壁运动异常（新的或恶化的先前存在的异常）。

结果

与负压结果的患者相比，负压结果的患者（n  = 28 [10%]）更常出现心血管危险因素、糖尿病并发症、血管疾病、主动脉瓣和二尖瓣环中度和重度钙化，甚至更糟静息 LV GLS (-16.7 ± 2.9% vs -19.0 ± 1.9%, P < .001)。在多变量逻辑回归分析中，DM 持续时间 > 10 年、糖尿病性视网膜病变、左室肥大和左室 GLS 受损（比值比，1.39 [95% CI，1.14-1.70] 每增加百分比；比值比，5.16 [95% CI，1.96 -13.59] LV GLS 低于 -18%）与负荷经胸超声心动图的阳性结果独立相关。LV GLS 预测阳性结果的曲线下面积为 0.74，截止值为 -18.0%（敏感性 68%，特异性 78%）。通过添加 LV GLS，预测测试结果的多变量模型曲线下面积得到改善（P  < .001），自举后的偏差校正曲线下面积为 0.842 [95% CI，0.753-0.893] .

结论

目前的研究结果表明，静息 LV GLS 与无症状缺血的存在相关，并且可能有助于更好地识别可能受益于冠状动脉疾病筛查的无症状 DM 患者。