| Objectives: Compared of left ventricular myocardial perfusion in patients with type 2 diabetes mellitus with normal coronary artery and healthy population by using the "onestop" examination of the heart of Revolution CT,and analyzed of the effect of coronary stenosis on left ventricular wall myocardial perfusion.Methods: We collected 169 patients with type 2 diabetes and healthy people from July 2017 to May 2018 in Qinghai Provincial People's Hospital,filtered and grouped by inclusion and exclusion criteria: including 20 patients with a simple type 2 diabetes group(diabetes group)with normal coronary artery,24 patients with non-diabetic(control group),42 patients with type 2 diabetes and coronary artery abnormality,completed one-stop examination of coronary angiography(CCTA)combined with resting CT myocardial perfusion imaging(CT-MPI).Two observers independently evaluated the quality of the CCTA image.Based on the 17-segment model of the American Heart Association(AHA),divided the left ventricular wall into 17 segments,and compared of differences in blood volume(BV),blood flow(BF),mean transit time(MTT),and time to peak(TTP)between the diabetes group and the control group.According to the degree of coronary stenosis,the coronary artery abnormalities of type 2 diabetes were divided into 16 cases of mild stenosis(<50%),14 patients with moderate stenosis(50%~75%),and 12 cases with severe stenosis(?75%),the changes of myocardial perfusion in the blood supply area of the diseased vessels between the three groups were analyzed.Results:(1)Compared of general clinical data,the fasting blood glucose and glycosylated hemoglobin values of the control group were lower than those of the diabetic group(P<0.05),there was no significant difference in the other clinical data between the two groups(P>0.05).(2)The mean BF value of the diabetes group(320 sections of myocardium)was lower than that of the control group(384 sections of myocardium),and the mean TTP and MTT values were higher than that of the control group(P<0.05);The mean BV value of the diabetes group was lower than that of the control group,but there was no statistical difference(P>0.05).(3)The mean BF value in the LAD,LCX and RCA blood supply areas of the diabetic group were lower than those of the control group,and the TTP and MTT values were higher than those of the control group(P<0.05);The BV value in the LAD,LCX and RCA blood supply areas of the diabetic group were lower than those of the control group,there was no significant difference(P>0.05).(4)With BF equal to 75ml/(100g.min)as the critical value,the myocardial segment of the diabetes group with the BF value less than the critical value accounted for 17.5%(56/320),and the myocardial segment with the BF value of the control group less than the critical value accounted for 9.9%(38/384),the difference was statistically significant(P<0.05).(5)Compared of myocardial perfusion parameters in the blood supply area of the mild,moderate and severe stenosis: As the degree of coronary artery stenosis increased,the BF value decreased overall,compared with the mild stenosis group,the BF value of the moderate and severe stenosis group was significantly lower(P<0.05),and the BF value of the severe stenosis group was lower than that of the moderate stenosis group,there was no significant difference(P>0.05);Compared with the mild stenosis group,the MTT value of the moderate and severe stenosis group was significantly increased(P<0.05),the MTT values in severe stenosis group were similar to those in moderate stenosis group;In the severe stenosis group,the BV value was significantly lower in the mild and moderate stenosis group(P<0.05),and the BV value in the moderate stenosis group was similar to that in the mild stenosis group;The TTP value of the moderate stenosis group was lower than that of the severe stenosis group,the difference was statistically significant(P<0.05).The TTP value of the moderate stenosis group was lower than that of the mild stenosis group,there was no significant difference(P>0.05).The TTP value of severe stenosis was higher than that of the mild stenosis group(P<0.05).Conclusions:(1)In patients with type 2 diabetes,left ventricular myocardial microcirculation been impaired and myocardial perfusion decreased before coronary stenosis.(2)Some type 2 diabetic patients with normal coronary CTA were likely to have focal myocardial ischemia or even necrosis,And the proportion of focal myocardial perfusion abnormalities in patients with type 2 diabetes was significantly higher than that of normal people.(3)With the severity of coronary artery stenosis,the myocardial blood flow in the left ventricular wall showed a downward trend,and the moderate and severe stenosis had a greater impact on myocardial blood flow;effective collateral circulation may be established in moderate or severe coronary stenosis.(4)The use of Revolution CT coronary CTA combined with resting CT-MPI "one-stop" examination can assess coronary anatomy information and myocardial microcirculation,and had good clinical application prospects. |
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