Aim: Coronary artery calcium (CAC) score has a role in stratifying cardiovascular risk in patients with diabetes. Cardio-ankle vascular index (CAVI) is also a useful method to detect coronary artery calcification. This study compares CAC score with CAVI in the prediction of cardiovascular events in patients with diabetes. Methods: From August 2006 to June 2008, a total of 626 patients with diabetes who received CAC score assessment with concomitant tests of ankle-brachial index and CAVI were included in this study. Results: During 4 years of follow-up, 98 participants developed cardiovascular events. There is an increased incidence of coronary revascularization and total cardiovascular events with higher categories of CAC score (P 0.05 when CAC score ≥ 100). The logistic regression analyses revealed pooled odd ratios for coronary revascularization, and total cardiovascular events were 1.25 [95% confidence interval (CI) 1.03 -1.51, P 0.021] and 1.23 (95% CI 1.07 -1.42, P 0.005), respectively, for high versus low CAVI (CAVI ≥ 9.0 vs CAVI 9.0). The logistic regression model revealed that a CAC score of ≥ 1000 rather than a CAVI of ≥ 9.0 had a higher predictive value for total cardiovascular events. Conclusions: A CAC score of ≥ 100 or a CAVI of ≥ 9.0 predicts future total cardiovascular events in asymptomatic patients with type 2 diabetes. Considering the advantages of CAVI, it can be used as one of the screening tools to reflect coronary atherosclerosis in these patients.

Background:Echocardiographic parameters could be implicated in the development of apical asynergy (characterized by apical sequestration or apical aneurysm) and worse cardiovascular outcome in patients with apical hypertrophic cardiomyopathy (ApHCM).Hypothesis:Echocardiographic parameters and morphological patterns of left ventriculograms are associated with cardiovascular morbidity and mortality in patients with ApHCM.Methods:We followed 47 cases with echocardiographically documented ApHCM. Echocardiographic findings of the extent and degree of hypertrophy, sustained cavity obliteration, and paradoxical diastolic jet flow were measured. All patients underwent a cardiac catheterization except for the cases whose informed consent was not acquired. The clinical manifestations were assessed and recorded by the attending physicians during 35.4 ± 23.7 months follow‐up.Results:Among the 47 patients with ApHCM, 30 patients presented as the “pure” form and 17 patients present as the “mixed” form. Seventeen of 28 patients with sustained cavity obliteration showed paradoxical flow by echocardiography. Thirty‐one underwent left ventriculograms and showed morphological abnormalities, including “ace‐of‐spades” configuration (15/31), apical sequestration (12/31), and apical aneurysm (4/31). The results demonstrated that cardiovascular morbidities occurred in 21 of 47 patients and were closely related to the presence of mixed form ApHCM, cavity obliteration, and paradoxical flow by univariate and multivariate Cox analysis. During the period of follow‐up, 4 patients (9.5%) died, and among them 3 had concomitant apical aneurysm.Conclusions:We concluded that detection of cavity obliteration and paradoxical flow and discrimination of pure form from mixed form by echocardiography, as well apical sequestration from apical aneurysm in ApHCM patients, is warranted. © 2011 Wiley Periodicals, Inc.This work was supported in part by grants from Lo‐Tung Poh‐Ai Hospital. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Type 2 diabetes mellitus (T2DM) is no longer regarded as a coronary risk equivalent, and heterogeneity of cardiovascular risk exists, suggesting that further risk stratification should be mandatory. This study aimed to determine the prevalence and clinical predictors of coronary artery calcium (CAC) score, and evaluate the CAC score as a predictor of cardiovascular outcome in a large asymptomatic T2DM cohort. Methods: A total of 2,162 T2DM patients were recruited from a Diabetes Shared Care Network and the CAC score was measured. Cardiovascular outcomes were obtained for 1,928 patients after a follow-up of 8.4 years. Multiple regression analysis and Cox proportional hazard regression were applied to identify clinical predictors of CAC and calculate the incidence and hazard ratios (HRs) for all-cause mortality and cardiovascular events by CAC category. Results: Of the recruited patients, 96.8% had one or more risk factors. The distribution of CAC scores was as follows: CAC 0 in 24.2% of the patients, 0 CAC ≤ 100 in 41.5%, 100 CAC ≤ 400 in 20.3%, CAC 400 in 14.7%. The multivariable predictor of increased CAC included age (years) (odds ratio, 1.07; 95% confidence interval, 1.06-1.08), male sex (1.82; 1.54-2.17), duration (years) of T2DM (1.07; 1.05-1.09), and multiple risk factors (1.94; 1.28-2.95). Increasing severity of CAC was associated with higher all-cause or cardiac mortality and higher incident cardiovascular events. The HRs for cardiac death or major cardiac events in CAC 400 vs CAC 0 were 8.67 and 10.52, respectively (p 0.001) Conclusion: CAC scoring provides better prognostication of cardiovascular outcome than traditional risk factors in asymptomatic T2DM patients, and may allow identifying a high-risk subset for enhancing primary prevention. without diabetes 1-3). From a pooled analysis of more than one million Asian participants, patients with diabetes had a 1.89-fold risk of all-cause death and a twofold risk of cardiovascular-related death compared with patients without diabetes 4). Two decades ago, diabetes was regarded as a "CHD risk equivalent," implying a 10-year cardiovascular risk of 20% for every diabetic patient according to Haffner's report 5) and other large observational studies 6, 7). However, several studies of different population cohorts provided varying conclusions on the concept of coronary risk Copyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

Multislice CT can offer high accuracy for the noninvasive detection of apical wall thickness and left ventricular configuration in patients with AHCM. It also provides additional information about significant coronary stenosis and MB in patients with chest pain. This promising technology has a potential to complement invasive cardiac catheterization in clinical practice.