Association between diabetes and different components of coronary atherosclerotic plaque burden as measured by coronary multidetector computed tomography

ArticleinAtherosclerosis 205(2):481-5 · February 2009with8 Reads
DOI: 10.1016/j.atherosclerosis.2009.01.015 · Source: PubMed
Abstract
The aim of the study was to assess differences in the presence, extent, and composition of coronary atherosclerotic plaque burden as detected by coronary multidetector computed tomography (MDCT) between patients with and without diabetes mellitus. We compared coronary atherosclerotic plaques (any plaque, calcified [CAP], non-calcified [NCAP, and mixed plaque [MCAP]]) between 144 symptomatic diabetic and non-diabetic patients (36 diabetics, mean age: 54.4+/-12, 64% females) who underwent coronary 64-slice MDCT (Siemens Medical Solutions, Forchheim, Germany) for the evaluation of acute chest pain but proven absence of myocardial ischemia. Patients with diabetes had a higher prevalence of any plaque, CAP, MCAP, and NCAP (p=0.08, 0.07, 0.05, and 0.05, respectively) and a significantly higher extent of any plaque, CAP, MCAP, and NCAP (3.8+/-4.2 vs. 2.0+/-3.2, p=0.01; 3.3+/-4.0 vs. 1.7+/-3.0, p=0.03; 1.4+/-2.6 vs. 0.6+/-1.5, p=0.03; and 1.9+/-3.0 vs. 1.0+/-1.9, p=0.03, respectively) as compared to controls. In addition, patients with diabetes had a significant higher prevalence of significant coronary artery stenosis (42% vs. 14%, p=0.0004) and an approximately 3.5-fold higher risk of significant coronary stenosis independent of the presence of hypertension and BMI (OR: 3.46, 95% CI: 1.37-8.74, p=0.009). Patients with diabetes have an approximately 3.5-fold higher risk of coronary stenosis independent of other cardiovascular risk factors and an overall increased coronary atherosclerotic plaque burden.
    • "Our study demonstrates that in a high-risk population with unknown CAD, as in the case of our DM patients, MDCT often find severe coronary atherosclerosis, both in terms of the number of patients with significant multivessel disease and atherosclerotic burden. This finding is in agreement with those of previous studies with 64-slice MDCT that indicated a higher prevalence of any type of coronary plaques and of significant coronary stenoses and a larger plaque burden in asymptomatic diabetics compared to non-diabetic patients [6,21]. These results support the concept that MDCT coronary angiography is an excellent noninvasive technique for early identification of significant CAD in high-risk patients with inconclusive or unfeasible noninvasive stress test results [24]. "
    [Show abstract] [Hide abstract] ABSTRACT: Diabetics have high prevalence of subclinical coronary artery disease (CAD) with typical characteristics (diffuse disease, large calcifications). Although 64-slice multidetector computed tomography (MDCT) coronary angiography has high diagnostic accuracy to detect CAD, its diagnostic performance in diabetics with suspected CAD is unknown. To compare the diagnostic performance of 64-slice MDCT between diabetics and non-diabetics with suspected CAD scheduled for invasive coronary angiography (ICA). We enrolled one hundred and five diabetic patients (92 men, age 65 +/- 9 years, Group 1) and 105 non-diabetic patients (63 men, age 63+/-5 years, Group 2) with indication to ICA for suspected CAD undergoing coronary 64-slice MDCT before ICA. In Group 1, the overall feasibility of coronary artery visualization was 93.8%. The most frequent artifact was blooming due to large coronary calcifications (54 artifacts, 67%). In Group 2, the overall feasibility was significantly higher vs. Group 1 (97%, p < 0.0001). In Group 1, the segment-based analysis showed a MDCT sensibility, specificity, positive predictive value, negative predictive value and accuracy for the detection of ≥50% luminal narrowing of 77%, 90%, 70%, 93% and 87%, respectively. In Group 2, all these parameters were significantly higher vs. Group 1. In the patient-based analysis, specificity, negative predictive value and accuracy were significantly lower in Group 1 vs. Group 2. Although MDCT has high sensitivity for early identification of significant CAD in diabetics, its diagnostic performance is significantly reduced in these patients as compared to non-diabetics with similar clinical characteristics.
    Full-text · Article · Nov 2010
    • "Detailed information concerning the metabolic control of patients, secondary organ damage or presence of autonomic dysfunction was unavailable. Recent reports have even demonstrated the ability of CTCA to detect differences in coronary plaque characteristics between patients with and without DM2021222324. However, characteristic of plaque composition has not been evaluated in the present population-based study. "
    [Show abstract] [Hide abstract] ABSTRACT: To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). 147 diabetic (mean age: 65 ± 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 ± 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. Diabetics showed a higher number of diseased segments (4.1 ± 4.2 vs. 2.1 ± 3.0; p < 0.0001); a higher rate of CCS > 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS ≤ 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS ≤ 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics.
    Full-text · Article · Nov 2010
    • "In addition, the patients in this study also had some co-existent cardiovascular risk factors besides type 2 DM, which may affect the results. However, several previous studies had confirmed that the difference in CAD between diabetic and non-diabetic patients was independent of cardiovascular risk factors other than DM [13,22,23]. Thus, the present results demonstrated the current condition of CAD in diabetic patients, which may be more consistent with the practice because diabetic patients often had other concomitant cardiovascular risk factors. "
    [Show abstract] [Hide abstract] ABSTRACT: Coronary artery disease (CAD) is a common and severe complication of type 2 diabetes mellitus (DM). The aim of this study is to identify the features of CAD in diabetic patients using coronary CT angiography (CTA). From 1 July 2009 to 20 March 2010, 113 consecutive patients (70 men, 43 women; mean age, 68 ± 10 years) with type 2 DM were found to have coronary plaques on coronary CTA. Their CTA data were reviewed, and extent, distribution and types of plaques and luminal narrowing were evaluated and compared between different sexes. In total, 287 coronary vessels (2.5 ± 1.1 per patient) and 470 segments (4.2 ± 2.8 per patient) were found to have plaques, respectively. Multi-vessel disease was more common than single vessel disease (p < 0.001), and the left anterior descending (LAD) artery (35.8%) and its proximal segment (19.1%) were most frequently involved (all p < 0.001). Calcified plaques (48.8%) were the most common type (p < 0.001) followed by mixed plaques (38.1%). Regarding the different degrees of stenosis, mild narrowing (36.9%) was most common (p < 0.001); however, a significant difference was not observed between non-obstructive and obstructive stenosis (50.4% vs. 49.6%, p = 0.855). Extent of CAD, types of plaques and luminal narrowing were not significantly different between male and female diabetic patients. Coronary CTA depicted a high plaque burden in patients with type 2 DM. Plaques, which were mainly calcified, were more frequently detected in the proximal segment of the LAD artery, and increased attention should be paid to the significant prevalence of obstructive stenosis. In addition, DM reduced the sex differential in CT findings of CAD.
    Full-text · Article · Nov 2010
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