[Type 2 diabetes mellitus and coronary artery disease: features of perfusion volume computed tomography of the heart in a pharmacological test with adenosine triphosphate].

IF 5.2 1区管理学 Q1 POLITICAL SCIENCE Journal of Public Administration Research and Theory Pub Date : 2023-05-31 DOI:10.26442/00403660.2023.04.202158

G N Soboleva, A A Minasyan, S A Gaman, A N Rogoza, L P Molina, T V Soboleva, M A Shariya, S K Ternovoy, Y A Karpov

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Abstract

Aim: To study myocardial perfusion in patients with coronary artery disease (CAD) with and without type 2 diabetes mellitus (DM) using volumetric computed tomography (VCT) of the heart with a pharmacological test with adenosine triphosphate (ATP).

Materials and methods: The study included 93 patients, of which 18 had CAD with DM, and 50 had CAD without DM. All patients underwent one of the stress tests, cardiac VCT with ATP test, invasive coronary angiography, or CT coronary angiography. Left ventricle (LV) myocardial perfusion was evaluated for hypoperfusion zones and the calculation of semi-quantitative indices: decrease of LV myocardial density, LV myocardial perfusion index, transmural perfusion coefficient, and our proposed new indicator - myocardial perfusion reserve (MPR).

Results: The MPR index value in the hypoperfusion zones in patients with CAD and DM was 0.64 [0.62-0.66], in patients with CAD without diabetes 0.65 [0.63-0.66]; p=0.4; the value of the transmural perfusion coefficient in the areas of abnormal LV myocardial perfusion in patients with CAD and DM was 0.81 [0.80-0.86] versus 0.83 [0.80-0.85] in patients with CAD without DM (p=0.6). More hypoperfusion segments were observed in patients with CAD and DM (33.3%) compared to those without DM (14%; p=0.029). The MPR index in the hypoperfusion zones in patients with CAD with intact coronary arteries (CA) and DM was 0.56 [0.54-0.60] versus 0.55 [0.54-0.62] in patients with CAD with intact CA without DM; p=0.2.

Conclusion: In patients with CAD and type 2 DM, according to the VCT with ATP test, more foci hypoperfusion areas were detected, regardless of the severity of coronary artery involvement, compared with patients with CAD without DM, which may be due to the microangiopathy in the myocardium. The similarity of the MPR parameters in the hypoperfusion zones associated with hemodynamic stenosis of the CA and with intact CAs indicates the ischemic genesis of these zones. For citation: Soboleva GN, Minasyan AA, Gaman SA, Rogoza AN, Molina LP, Soboleva TV, Shariya MA, Ternovoy SK, Karpov YuA. Type 2 diabetes mellitus and coronary artery disease: features of perfusion volume computed tomography of the heart in a pharmacological test with adenosine triphosphate. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(4):309-315. DOI: 10.26442/00403660.2023.04.202158.

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[2型糖尿病与冠状动脉疾病：三磷酸腺苷药理试验中心脏灌注容积计算机断层扫描的特征]。

目的：使用心脏容积计算机断层扫描（VCT）和三磷酸腺苷（ATP）药理测试，研究伴有和不伴有 2 型糖尿病（DM）的冠状动脉疾病（CAD）患者的心肌灌注情况：研究包括 93 名患者，其中 18 人患有伴有 DM 的 CAD，50 人患有不伴有 DM 的 CAD。所有患者均接受了压力测试、心脏VCT与ATP测试、有创冠状动脉造影术或CT冠状动脉造影术中的一种。对低灌注区的左心室心肌灌注进行了评估，并计算了半定量指标：左心室心肌密度下降、左心室心肌灌注指数、跨壁灌注系数以及我们提出的新指标--心肌灌注储备（MPR）：CAD合并DM患者低灌注区的MPR指数值为0.64[0.62-0.66]，CAD非糖尿病患者为0.65[0.63-0.66]；P=0.4；CAD合并DM患者左心室心肌灌注异常区的跨壁灌注系数值为0.81[0.80-0.86]，CAD非糖尿病患者为0.83[0.80-0.85]（P=0.6）。与未患有糖尿病的患者（14%；P=0.029）相比，患有 CAD 和糖尿病的患者（33.3%）出现更多的低灌注区段。在有完整冠状动脉（CA）和DM的CAD患者中，低灌注区的MPR指数为0.56[0.54-0.60]，而在有完整CA但无DM的CAD患者中，低灌注区的MPR指数为0.55[0.54-0.62]；P=0.2：在CAD合并2型DM的患者中，根据VCT和ATP测试，无论冠状动脉受累的严重程度如何，与没有DM的CAD患者相比，都能检测到更多的低灌注灶，这可能是由于心肌中的微血管病变所致。与冠状动脉血流动力学狭窄相关的低灌注区和与完整的冠状动脉相关的低灌注区的 MPR 参数相似，这表明这些区域是缺血性的。供引用：Soboleva GN, Minasyan AA, Gaman SA, Rogoza AN, Molina LP, Soboleva TV, Shariya MA, Ternovoy SK, Karpov YuA.2 型糖尿病与冠状动脉疾病：三磷酸腺苷药理试验中心脏灌注容积计算机断层扫描的特征》。Terapevticheskii Arkhiv (Ter. Arkh.).2023;95(4):309-315.DOI: 10.26442/00403660.2023.04.202158.

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Journal of Public Administration Research and Theory Multiple-

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8.50

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11.90%

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期刊介绍： The Journal of Public Administration Research and Theory serves as a bridge between public administration or public management scholarship and public policy studies. The Journal aims to provide in-depth analysis of developments in the organizational, administrative, and policy sciences as they apply to government and governance. Each issue brings you critical perspectives and cogent analyses, serving as an outlet for the best theoretical and research work in the field. The Journal of Public Administration Research and Theory is the official journal of the Public Management Research Association.