Thallium tomographic imaging and exercise electrocardiography were performed on 136 diabetic patients without symptoms of heart disease. Thirty three patients had post-exercise thallium defects and 19 had ST 1 mm greater than or equal to segment depression during exercise electrocardiography. Both tests were positive in 13 patients. Coronary angiography was subsequently performed on 33 patients with either scintigraphic and/or electrocardiographic evidence of myocardial ischaemia. Angiographically significant coronary artery disease (greater than or equal to 50% narrowing of the coronary artery lumen) was detected in 13 patients. Six patients had minimal coronary artery stenosis (less than 50%), and 14 had normal coronary arteries. Six patients refused cardiac catheterisation. In 14 out of 27 patients with post-exercise thallium defects coronary angiography did not show any coronary artery stenoses (positive predictive accuracy 48%). Exercise electrocardiography showed only one false positive result (positive predictive accuracy 94%) but failed to detect coronary artery disease in three patients with a positive scintigraphic result. The accuracy of a positive exercise electrocardiographic test seems to be better than that of a positive thallium tomographic scan for detecting asymptomatic coronary artery disease in diabetic patients. The high number of false positive thallium defects may be the result of technical features inherent in thallium tomography and/or the possible disease of the small intramyocardial arteries in diabetic patients.

译文

对136例无心脏病症状的糖尿病患者进行了th断层显像和运动心电图检查。运动心电图期间,有33例患者存在运动后th缺陷,19例ST 1毫米大于或等于节段压低。13例患者的两项测试均为阳性。随后对33例具有心肌缺血的闪烁显像和/或心电图证据的患者进行了冠状动脉造影。在13例患者中检测到血管造影显著的冠状动脉疾病 (大于或等于冠状动脉腔的50% 变窄)。6例冠状动脉狭窄 (小于50%),14例冠状动脉正常。六名患者拒绝心脏导管插入术。在运动后th缺陷的27例患者中,有14例冠状动脉造影未显示任何冠状动脉狭窄 (阳性预测准确性48%)。运动心电图仅显示一个假阳性结果 (阳性预测准确性94%),但未能在三个闪烁显像结果阳性的患者中检测到冠状动脉疾病。在糖尿病患者中,积极的运动心电图测试的准确性似乎比阳性的th断层扫描的准确性更好。大量假阳性th缺陷可能是th断层扫描固有的技术特征和/或糖尿病患者心肌小动脉的可能疾病的结果。

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