Abstract
Background
As one of the most frequent risk factors for cardiovascular disease, type 2 diabetes mellitus (T2DM) is one of the largest causes of death. However, an acute cardiac presentation is not uncommon in diabetic patients, and the current investigative approach remains often inadequate. The aim of our study was to retrospectively stratify the risk of asymptomatic T2DM patients using low-dose 640-slice coronary computed tomography angiography (CCTA).
Materials and methods
CCTA examinations of 62 patients (mean age, 65 years) with previous diagnosis of type 2 diabetes and without cardiac symptoms were analyzed. Image acquisition was performed using a 640-slice CT. Per-patient, per-vessel and per-plaque analyses were performed. Stratification risk was evaluated according to the ESC guidelines. The patients were followed up after 2.21 ± 0.56 years from CCTA examination.
Results
Coronary artery disease (CAD) was found in 58 patients (93.55%) presenting 290 plaques. Analysis of all samples showed severe-to-occlusive atherosclerosis in 24 patients (38.7% of cases). However, over the degree of stenosis, 23 patients were evaluated at high risk considering the extension of CAD. Good agreement was shown by the correlation of CAD extension/risk estimation and MACE incidence, according to a Kaplan–Meier survival analysis (p value = 0.001), with a 7.25-fold increased risk (HR 7.25 CI 2.13–24.7; p value = 0.002).
Conclusion
Our study confirms the high capability of CCTA to properly stratify the CV risk of asymptomatic T2DM patients. Its use could be recommended if we consider how current investigative strategies to correctly assess these patients often seem inadequate.
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Abbreviations
- T2DM:
-
Type 2 diabetes mellitus
- CAD:
-
Coronary artery disease
- CCTA:
-
Coronary computed tomography angiography
- MACE:
-
Major adverse cardiac events
- CHF:
-
Chronic heart failure
- PCI:
-
Percutaneous coronary intervention
- ECG:
-
Electrocardiogram
- AEC:
-
Automatic exposure control
- SD:
-
Standard deviation
- FOV:
-
Field of view
- DLP:
-
Dose length product
- MPR:
-
Multiplanar reconstruction
- MIP:
-
Maximum intensity projection
- VR:
-
Volume rendering
- AHA:
-
American Heart Association
- HU:
-
Hounsfield unit
- ESC:
-
European Society of Cardiology
- CS:
-
Calcium score
- ANOVA:
-
Analysis of variance
- LMA:
-
Left main artery
- LDA:
-
Left descending artery
- CX:
-
Circumflex artery
- RCA:
-
Right coronary artery
- ICA:
-
Invasive coronary angiography
- OMT:
-
Optimal medical therapy
- CABG:
-
Coronary artery bypass grafting
- HR:
-
Hazard ratio
- CV:
-
Cardiovascular
- PET:
-
Positron emission tomography
- CMR:
-
Cardiac magnetic resonance
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The authors wish to thank Angela Martella for the English revision manuscript.
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Palumbo, P., Cannizzaro, E., Bruno, F. et al. Coronary artery disease (CAD) extension-derived risk stratification for asymptomatic diabetic patients: usefulness of low-dose coronary computed tomography angiography (CCTA) in detecting high-risk profile patients. Radiol med 125, 1249–1259 (2020). https://doi.org/10.1007/s11547-020-01204-z
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DOI: https://doi.org/10.1007/s11547-020-01204-z