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to体层断层显像和运动心电图检查。在运动心电图检查中,有33例运动后al缺陷患者,其中19例ST大于或等于节段压低1 mm。两项测试均阳性13例。随后对33例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例患者中发现了具有血管造影意义的冠状动脉疾病(大于或等于50%的冠状动脉腔狭窄)。 6例患者的冠状动脉狭窄程度最小(少于50%),而14例具有正常的冠状动脉。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(阳性预测准确性为48%)。运动心电图检查仅显示一个假阳性结果(阳性预测准确率94%),但在3个闪烁显像结果阳性的患者中未能检测到冠心病。积极的运动心电图检查的准确性似乎比阳性的X线体层摄影检查的准确性要好,以检测糖尿病患者的无症状冠状动脉疾病。大量假阳性positive缺陷可能是may断层扫描固有的技术特征和/或糖尿病患者心肌小动脉可能的疾病的结果。

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