Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics?: results of a long term follow-up

Faustino, Ana; Providência, Rui; Mota, Paula; Barra, Sérgio; Silva, Joana; Fernandes, Andreia; Catarino, Rui; Basso, Susana; Costa, Marco; Leitão‐Marques, António

doi:10.1186/1471-2261-14-2

Cited by 12 publications

(13 citation statements)

References 25 publications

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“…With regard to CAC, several studies in patients with type 2 diabetes have demonstrated CAC to be a useful risk marker for CVD events and mortality [ 15 , 27 – 31 ]. An extensive high CAC (>600) has been shown to be related to high risk of developing chronic CAD-related events; whereas acute CAD-related events mainly occurred in subjects with mild and moderate CAC score (1–600) [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

Scholten

Reinhard

Hansen

et al. 2015

Cardiovasc Diabetol

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BackgroundIn patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diabetes and microalbuminuria (>30 mg/24-h), but without known coronary artery disease. Moreover, we assessed the predictive value of a predefined categorisation of patients into a high- and low-risk group at baseline.MethodsProspective study including 200 patients. All received intensive multifactorial treatment. Patients with baseline NT-proBNP >45.2 ng/L and/or CAC ≥400 were stratified as high-risk patients (n = 133). Occurrence of fatal- and nonfatal CVD (n = 40) and mortality (n = 26), was traced after 6.1 years (median).ResultsHigh-risk patients had a higher risk of the composite CVD endpoint (adjusted hazard ratio [HR] 10.6 (95 % confidence interval [CI] 2.4-46.3); p = 0.002) and mortality (adjusted HR 5.3 (95 % CI 1.2-24.0); p = 0.032) compared to low-risk patients. In adjusted continuous analysis, both higher NT-proBNP and CAC were strong predictors of the composite CVD endpoint and mortality (p ≤ 0.0001). In fully adjusted models mutually including NT-proBNP and CAC, both risk factors remained associated with risk of CVD and mortality (p ≤ 0.022). There was no interaction between NT-proBNP and CAC for the examined endpoints (p ≥ 0.31).ConclusionsIn patients with type 2 diabetes and microalbuminuria but without known coronary artery disease, NT-proBNP and CAC were strongly associated with fatal and nonfatal CVD, as well as with mortality. Their additive prognostic capability holds promise for identification of patients at high risk.

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Section: Discussionmentioning

confidence: 99%

Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

Scholten

Reinhard

Hansen

et al. 2015

Cardiovasc Diabetol

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“…Also Faustino et al investigated the prognostic value of coronary CTA for cardiovascular events in 85 asymptomatic patients with DM type 2. 24 Cardiovascular events occurred in 10 (11.8%) patients after median follow-up of 48 (IQR 18-68) months: cardiovascular death in 2 (2.4%) patients, unstable angina in 1 (1.2%) patients, stroke 7 (8.4%) in patients. In the multivariate analyses, corrected for univariate significant variables, the absence of obstructive CAD (≥50%) was independently protective of events.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few studies assessed the prognostic value of coronary CTA in diabetic patients without chest pain syndrome. 15 , 22 , 24 From the CONFIRM (coronary CT angiography evaluation for clinical outcomes: an international multicentre) registry of 27,125 patients, Min et al selected 400 asymptomatic diabetic patients who underwent coronary CTA. 15 The prognostic value of CTA was investigated using the same composite endpoint as in the present study.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of coronary computed tomography angiography in diabetic patients without chest pain syndrome

Hoogen

Graaf

Roos

et al. 2016

Journal of Nuclear Cardiology

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AimsDiabetic patients with coronary artery disease (CAD) are often free of chest pain syndrome. A useful modality for non-invasive assessment of CAD is coronary computed tomography angiography (CTA). However, the prognostic value of CAD on coronary CTA in diabetic patients without chest pain syndrome is relatively unknown. Therefore, the aim was to investigate the long-term prognostic value of coronary CTA in a large population diabetic patients without chest pain syndrome.MethodsBetween 2005 and 2013, 525 diabetic patients without chest pain syndrome were prospectively included to undergo coronary artery calcium (CAC)-scoring followed by coronary CTA. During follow-up, the composite endpoint of all-cause mortality, non-fatal myocardial infarction (MI), and late revascularization (>90 days) was registered.ResultsIn total, CAC-scoring was performed in 410 patients and coronary CTA in 444 patients (431 interpretable). After median follow-up of 5.0 (IQR 2.7-6.5) years, the composite endpoint occurred in 65 (14%) patients. Coronary CTA demonstrated a high prevalence of CAD (85%), mostly non-obstructive CAD (51%). Furthermore, patients with a normal CTA had an excellent prognosis (event-rate 3%). An incremental increase in event-rate was observed with increasing CAC-risk category or coronary stenosis severity. Finally, obstructive (50-70%) or severe CAD (>70%) was independently predictive of events (HR 11.10 [2.52;48.79] (P = .001), HR 15.16 [3.01;76.36] (P = .001)). Obstructive (50-70%) or severe CAD (>70%) provided increased value over baseline risk factors.ConclusionCoronary CTA provided prognostic value in diabetic patients without chest pain syndrome. Most importantly, the prognosis of patients with a normal CTA was excellent.

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“…Some of these features are associated with a higher likelihood of near-term major adverse cardiovascular events. Several studies have shown the prognostic value of CCTA findings in subjects with asymptomatic DM 31 , 32 . Whether clinical outcomes can be impacted by CCTA screening, however, was only recently reported by the FACTOR-64 randomized clinical trial, which enrolled 900 asymptomatic patients with diabetes; while showing a 20% reduced risk of subsequent adverse cardiovascular events in those screened with CCTA, the findings were not statistically significant and this was due in part to the fairly low event rates 33 .…”

Section: Key Screening Methods For Detecting Subclinical Cardiovasculmentioning

confidence: 99%

Should adults with type 2 diabetes be screened for atherosclerotic cardiovascular disease?

Zhao

Wong

2015

F1000Res

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Diabetes mellitus is associated with greater risks for cardiovascular diseases (CVD). Multiple noninvasive screening tools for CVD including cardiac CT, carotid intima-media thickness test, myocardial perfusion imaging have been examined in those with diabetes, but the prognostic value of these tests vary and issues remain regarding their cost-benefit ratios, potential harms of radiation, and how they fit into screening algorithms for CVD. We discuss in this report the needs and criteria for screening tests and summarize the evidence from observational studies and clinical trials. We also explore whether there should be more sensitive screening modalities to better detect both short and long-term cardiovascular risk among asymptomatic patients with diabetes.

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Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics?: results of a long term follow-up

Cited by 12 publications

References 25 publications

Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

Prognostic value of coronary computed tomography angiography in diabetic patients without chest pain syndrome

Should adults with type 2 diabetes be screened for atherosclerotic cardiovascular disease?

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