Comparison of the diagnostic performance of 64-slice computed tomography coronary angiography in diabetic and non-diabetic patients with suspected coronary artery disease

Abstract

BackgroundDiabetics 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).MethodsWe 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.ResultsIn 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.ConclusionsAlthough 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.

Low-dose CT coronary angiography for assessment of coronary artery disease in patients with type 2 diabetes - A cross-sectional study

“…Some studies have shown smaller coronary vessel calibre in patients with T2DM as compared to those without [ 27 , 28 ], and this may affect the diagnostic accuracy of CCTA. Reduced diagnostic performance of CCTA in patients with T2DM is reported in the only known study comparing with patients without T2DM [ 10 ], but this study included mainly symptomatic patients and the prevalence of obstructive CAD was high. On the other side, a mean CAC value of 269 and 18 % patients with zero CAC score would also render CCTA a suboptimal test to rule out obstructive CAD among symptomatic patients [ 19 ].…”

“…Coronary computed tomography angiography (CCTA) has over recent years emerged as an alternative to ICA for CAD assessment and the 64-slice generation scanners multidetector computer tomography (MDCT) is now considered to have high diagnostic performance for detection of significant coronary stenosis [ 7 ] in different populations. So far only few studies have assessed the role of MDCT in patients with T2DM [ 8 , 9 ], and its full potential is not fully understood, in particular in light of studies being suggestive of a reduced diagnostic performance of MDCT compared to non-T2DM populations [ 10 ]. Thus, the role of CCTA is considered uncertain in asymptomatic high-risk patients like patients with T2DM [ 11 ].…”

Diagnostic accuracy of coronary angiography using 64-slice computed tomography in coronary artery disease

“… 24 Diagnostic performance of 64-slice CT angiography was significantly reduced in diabetic patients than non-diabetics with similar clinical characteristics. 25 These findings suggest that 64-slice CT angiography could be used for screening CAS in low risk patients. In addition, high radiation exposure is another concern.…”

Hemoglobin A1C Levels are Independently Associated with the Risk of Coronary Atherosclerotic Plaques in Patients without Diabetes: A Cross-Sectional Study

“…Furthermore, all study subjects were enrolled at our healthcare center, not cardiovascular clinic, were not diagnosed with diabetes, did not have a prior history of CAD, and the coronary atherosclerosis was not severe. Therefore, we used SIS (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) to represent the degree of coronary plaque involvement, and not SSS (1-48), because few subjects had a high SSS. Actually, strong correlations were observed between the SSS, SIS, ABOS and calcium scores ( Supplementary Table 3).…”