Valor do teste ergométrico na detecção de isquemia miocárdica silenciosa em pacientes diabéticos / Exercise stress test for the detection of silent myocardial ischemia indiabetic patients

RESUMO

Em portadores de diabetes mellitus (DM), o diagnóstico de doença arterial coronariana (DAC) é comumente tardio devido à presença de isquemia miocárdica silenciosa (IMS). O objetivo do presente estudo foi avaliar os fatores de risco cardiovascular e a freqüência de IMS, em portadores de DM. Foram estudados 125 indivíduos: 42 portadores de DM e de hipertensão arterial (HA) (grupo 1), 22 portadores de DM, sem HA (grupo 2); 32 portadores de HA, sem DM (grupo 3) e 29 indivíduos sem DM e HA (grupo 4). Foram obtidos dados sobre duração do DM, história familiar de coronariopatia, história de tabagismo, dosagens de colesterol total e HDL, triglicérides, creatinina plasmática e relação albumina-creatinina, em amostra isolada de urina. Todos os indivíduos foram submetidos a avaliação cardiológica e teste ergométrico (TE). O índice de massa corporal foi semelhante entre os grupos. Os valores de colesterol total foram 207±38mg/dL, 231±35mg/dL, 214±47mg/dL, 216±51mg/dL (ns); HDLcolesterol: 47±13mg/dL, 42±7mg/dL, 41±8mg/dL, 48±15mg/dL (ns), LDL colesterol: 123±36mg/dL, 165±70mg/dL, 152±62mg/dL, 139±48mg/dL (p<0,05, grupos 1 e 4 vs grupos 2 e 3), triglicérides: 196±175mg/dL, 164±51mg/dL, 176±108mg/dL, 158±68mg/dL (ns), nos grupos 1, 2, 3 e 4, respectivamente. O TE foi positivo para isquemia miocárdica em 19 (15,2%) indivíduos, sendo 14 (73,7%) do grupo 1. A elevada freqüência de IMS observada em portadores de DM e HA sugere que a realização do TE seja incorporada na avaliação de rotina dessa população de risco.

ABSTRACT

Coronary artery disease (CAD) in patients with diabetes mellitus (DM) is diagnosed late in part due to silent myocardial ischemia (SMI). The aim of this study were to evaluate cardiovascular risk factors and the frequency of SMI in patients with DM. One-hundred and twenty-five individuals were studied: 42 diabetic hypertensive patients (group 1), 22 diabetic normotensive patients (group 2); 32 non-diabetic hypertensive patients (group 3) and 29 non-diabetic normotensive individuals (group 4). Data on DM duration, family history for coronary disease, cigarette smoking, total and HDL cholesterol, triglycerides, creatinine and urinary albumin-urinary creatinine ratio were obtained. Cardiovascular evaluation and exercise stress test (EST) were performed for all subjects. Mean body massindex was similar in the 4 groups. Values of total cholesterol were 207±38 mg/dL, 231±35 mg/dL, 214±47 mg/dL, 216±51 mg/dL (ns); HDL-cholesterol: 47±13 mg/dL, 42±7 mg/ dL, 41±8 mg/dL, 48±15 mg/dL (ns), LDL cholesterol: 123±36 mg/dL, 165±70 mg/dL, 152±62 mg/dL, 139±48 mg/dL (p<0,05, group 1 and 4 vs groups 2 and 3), triglycerides: 196±175 mg/dL, 164±51 mg/dL, 176±108 mg/dL, 158±68 mg/dL (ns), in groups 1, 2, 3and 4, respectively. Nineteen subjects (15,2%) had a positive EST for myocardial ischemia. Among them, 14 (73,7%) were from group 1. The high frequency of SMI observed in diabetic hypertensive patients suggests that EST should be considered as a routine test for evaluation of this high-risk population.