Prevalence of coronary artery disease and plaque morphology assessed by multi-slice computed tomography coronary angiography and calcium scoring in asymptomatic patients with type 2 diabetes

Scholte, Arthur J.; Schuijf, Joanne D.; Kharagjitsingh, Aan V.; Jukema, J. Wouter; Pundziūtė, Gabija; Wall, E. E. van der; Bax, Jeroen J.

doi:10.1136/hrt.2007.121921

Cited by 141 publications

(104 citation statements)

References 29 publications

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“…In this study, approximately two-thirds of plaque volume was noncalcified, and the correlation between CAC and coronary CT angiography plaque index was only moderate (r = 0.47-0.57). The differences between CAC and PVI were greater in diabetic patients with low levels of CAC where CAC-based risk stratification is known to be poor and noncalcified plaque is more common (29). In addition to age and sex, CAC score was associated with hypertension, whereas plaque index was associated with BMI.…”

Section: Cardiac Imaging: Coronary Artery Plaque Volume and Obesity Imentioning

confidence: 76%

“…Diabetic patients may have extensive noncalcified plaque not otherwise revealed with the CAC score (29), and lipid-containing plaque is greater in diabetic patients than in nondiabetic patients (30,31). CAC score is not a useful marker for assessing the reduction of plaque as a result of therapy, likely because CAC does not accurately reflect a change in modifiable noncalcified plaque (32).…”

Section: Cardiac Imaging: Coronary Artery Plaque Volume and Obesity Imentioning

confidence: 99%

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Coronary Artery Plaque Volume and Obesity in Patients with Diabetes: The Factor-64 Study

Kwan¹,

May²,

Cater³

et al. 2014

Radiology

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Purpose:To determine the relationship between coronary plaque detected with coronary computed tomographic (CT) angiography and clinical parameters and cardiovascular risk factors in asymptomatic patients with diabetes. Materials and Methods:All patients signed institutional review board-approved informed consent forms before enrollment. Two hundred twenty-four asymptomatic diabetic patients (121 men; mean patient age, 61.8 years; mean duration of diabetes, 10.4 years) underwent coronary CT angiography. Total coronary artery wall volume in all three vessels was measured by using semiautomated software. The coronary plaque volume index (PVI) was determined by dividing the wall volume by the coronary length. The relationship between the PVI and cardiovascular risk factors was determined with multivariable analysis. Results:The mean PVI (6standard deviation) was 11.2 mm 2 6 2.7. The mean coronary artery calcium (CAC) score (determined with the Agatston method) was 382; 67% of total plaque was noncalcified. The PVI was related to age (standardized b = 0.32, P , .001), male sex (standardized b = 0.36, P , .001), body mass index (BMI) (standardized b = 0.26, P , .001), and duration of diabetes (standardized b = 0.14, P = .03). A greater percentage of soft plaque was present in younger individuals with a shorter disease duration (P = .02). The soft plaque percentage was directly related to BMI (P = .002). Patients with discrepancies between CAC score and PVI rank quartiles had a higher percentage of soft and fibrous plaque (18.7% 6 3.3 vs 17.4% 6 3.5 [P = .008] and 52.2% 6 7.2 vs 47.2% 6 8.8 [P , .0001], respectively). Conclusion:In asymptomatic diabetic patients, BMI was the primary modifiable risk factor that was associated with total and soft coronary plaque as assessed with coronary CT angiography.q RSNA, 2014 Clinical trial registration no. NCT00488033

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Section: Cardiac Imaging: Coronary Artery Plaque Volume and Obesity Imentioning

confidence: 76%

Section: Cardiac Imaging: Coronary Artery Plaque Volume and Obesity Imentioning

confidence: 99%

Coronary Artery Plaque Volume and Obesity in Patients with Diabetes: The Factor-64 Study

Kwan¹,

May²,

Cater³

et al. 2014

Radiology

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“…In this study, we focused on two features of coronary artery plaque, namely, positive remodeling and low attenuation. Although a number of previous studies have described coronary CT angiography of diabetic patients, [14][15][16][17][18][19][20][21][22] our study is the first to focus on these particular features of plaque.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of significant stenosis of symptomatic patients and asymptomatic patients ranged from 33 to 42%, 15,19,21) and 15.2 to 29%, 16,20,22) respectively. A study containing both populations reported that the prevalence was 37%.…”

Section: Characteristics Of Coronary Ct Angiography Of Diabetic Patiementioning

confidence: 99%

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

et al. 2012

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SummaryDiabetic patients with coronary artery disease are often asymptomatic, making appropriate care of such patients difficult. The purpose of this study was to investigate the prevalence of coronary lesions in asymptomatic diabetic patients. Coronary computed tomography (CT) angiography was performed in 120 consecutive diabetic patients (90 of whom were men, mean age 65, mean HbA1c 7.2%). Images from patients whose coronary artery calcium scores (CAC scores) were less than 400 were subjected to stenosis and plaque analysis. Significant stenosis was defined as coronary artery stenosis > 70%. High-risk plaque was defined as plaque having both a CT density < 30 Hounsfield Units (HU) and showing positive remodeling. Significant stenoses were identified in 30.5% of the patients. High-risk plaques were identified in 17.1% of the patients. Less than half of the high-risk plaques were obstructive plaques. There was a statistically significant association between significant stenosis and high-risk plaque by chi-square test (P = 0.022). We found significant stenosis even in patients whose CAC score = 0 at a rate of 5.0%. Using univariate logistic-regression analysis, we found that coronary risk factors associated with significant stenosis and high-risk plaque were dyslipidemia (P = 0.033) and current smoking (P = 0.030), respectively. We report for the first time, the prevalence of high-risk plaques in the arteries of patients with asymptomatic diabetes, as assessed by coronary CT angiography. (Int Heart J 2012; 53: 23-28) Key words: Diabetes mellitus, Coronary CT angiography, Asymptomatic diabetes, Vulnerable plaque A cute coronary syndrome is a major health concern in individuals with type 2 diabetes. The quantitative risk of myocardial infarction or cardiac death in diabetic patients is similar to that of patients with a history of myocardial infarction.1) Diabetic patients are also prone to sudden cardiac death.2) However, many diabetic patients are asymptomatic, or have atypical symptoms of coronary heart disease. The reason is thought to be related to autonomic denervation of the heart.3) Therefore, protection of these patients from cardiac events is difficult, and makes the identification of preclinical atherosclerosis even more pressing in diabetic patients.Acute coronary syndrome is mostly triggered by rupture of vulnerable plaque. Recent technological advances such as contrast-enhanced coronary CT angiography now allow the visualization of coronary artery plaques easily and less-invasively. Several studies have used these new techniques to characterize plaque features that are causally related to acute coronary syndrome.4-6) Therefore, it is quite possible that one can now identify vulnerable plaque on CT images.In this cross-sectional study, we analyzed coronary CT angiography findings of asymptomatic diabetic patients. We paid special attention to the analysis of plaque in terms of vulnerability. We believe our report is unique in assessing plaque vulnerability in asymptomatic diabetes. Methods Study des...

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“…Asymptomatic diabetic patients have also been evaluated using MSCT, 21 with the result of CAD in 80% of patients and significant stenosis in 26%. Although the prevalence of CAD was similar to our results (90%), significant stenoses were less prevalent (26% vs. 48%).…”

Section: Discussionmentioning

confidence: 99%

Coronary artery disease is detectable by multi-slice computed tomography in most asymptomatic type 2 diabetic patients at high cardiovascular risk

Nasti

Carbonara

Stefano³

et al. 2011

Diabetes and Vascular Disease Research

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Objective: Non-invasive testing often does not identify coronary artery disease (CAD) in diabetic subjects. This study was designed in order to examine the prevalence of CAD in a cohort of asymptomatic type 2 diabetic patients at high cardiovascular risk and negative nuclear imaging, using multi-slice computed tomography (MSCT) angiography. Methods: In total, 770 type 2 diabetic patients were screened from January 2008 through July 2010. Of these, 132 Caucasians with diabetic nephropathy and asymptomatic for angina were eligible for a cross-sectional study. Patients underwent MSCT after ischaemia was excluded by myocardial Single Photon Emission Computed Tomography (SPECT) at rest and after dynamic exercise. When obstructive plaques were found (≥50% lumen narrowing), patients were sent to conventional coronary angiography (CCA). Results: Six subjects were not included in the analysis because of motion artefacts. MSCT was positive for CAD in 114 patients (90%). Within patients with positive MSCT, 60 (48% of all) showed one or more obstructive plaques. CCA confirmed significant stenosis (≥50%) in 48 of these 60 patients (80%). Some 21 (35%) showed stenosis ≥75% and were submitted to the revascularisation procedure. Conclusion: MSCT seems to better identify CAD than myocardial SPECT in asymptomatic patients with type 2 diabetes and diabetic nephropathy.

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Prevalence of coronary artery disease and plaque morphology assessed by multi-slice computed tomography coronary angiography and calcium scoring in asymptomatic patients with type 2 diabetes

Cited by 141 publications

References 29 publications

Coronary Artery Plaque Volume and Obesity in Patients with Diabetes: The Factor-64 Study

Coronary Artery Plaque Volume and Obesity in Patients with Diabetes: The Factor-64 Study

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

Coronary artery disease is detectable by multi-slice computed tomography in most asymptomatic type 2 diabetic patients at high cardiovascular risk

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