Atherosclerosis

2009

DOI: 10.1016/j.atherosclerosis.2009.01.015

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Association between diabetes and different components of coronary atherosclerotic plaque burden as measured by coronary multidetector computed tomography

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Christopher L. Schlett

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et al.

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Characteristics Of Coronary Ct Angiography Of Diabetic Patie2

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Cited by 22 publications

(24 citation statements)

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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%

“…18) Meanwhile, the reported prevalence of significant stenosis in symptomatic nondiabetic patients ranges from 14 to 36%. 15,19,21) In our study, 30% of patients with asymptomatic diabetes had significant stenosis. This percentage is within the range of percentages reported for patients with symptoms.…”

Section: Characteristics Of Coronary Ct Angiography Of Diabetic Patiementioning

confidence: 94%

“…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%

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

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et al. 2012

Int. Heart J.

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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...

“…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%

“…18) Meanwhile, the reported prevalence of significant stenosis in symptomatic nondiabetic patients ranges from 14 to 36%. 15,19,21) In our study, 30% of patients with asymptomatic diabetes had significant stenosis. This percentage is within the range of percentages reported for patients with symptoms.…”

Section: Characteristics Of Coronary Ct Angiography Of Diabetic Patiementioning

confidence: 94%

“…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%

See 1 more Smart Citation

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

¹

,

²

,

³

et al. 2012

Int. Heart J.

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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...

“…24, 31 Although CKD is also a significant risk factor, few reports have focused on coronary plaque burden and characteristics revealed on CCTA in such patients. We attribute this to the fact that CCTA using contrast material has been regarded as an inappropriate modality for patients with CKD because of the risk of developing CIN.…”

Section: Discussionmentioning

confidence: 99%

Coronary Plaque Characteristics in Patients With Mild Chronic Kidney Disease

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et al. 2012

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“…Framingham Heart Study identified traditional CVD risk factors related to coronary plaque characteristics (Bamberg et al 2008;Weiner et al 2008;Yun et al 2009;Cheng et al 2010;Nasir et al 2010). Schuijf et al (2007) reported an association of plaques with low Hounsfield units with acute coronary syndrome; they showed that the MP type accounts for half of stenotic vessels in patients with acute coronary syndrome (Kunimasa et al 2005;Schuijf et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Association between Renal Dysfunction and the Mixed Plaque of Coronary Artery on Computed Tomographic Angiography

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et al. 2011

Tohoku J. Exp. Med.

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Coronary artery plaque is related to development of coronary artery disease (CAD), and chronic kidney disease is associated with CAD. However, the association of renal dysfunction (RD) with coronary artery plaque characteristics has not been fully elucidated. We evaluated the association between RD and coronary artery plaque characteristics in patients with suspected CAD, who underwent multislice computed tomographic angiography (CTA). A total of 918 patients were classified into 4 groups: group with no plaque (NP) (48.9%), group with calcified plaque (CP) (16.0%), group with noncalcified plaque (NCP) (22.4%), and group with mixed plaque (MP) (12.7%). NCP is considered as rupture-prone soft plaque, and CP as more stable lesion. The mean of estimated glomerular filtration rate (eGFR) was 82.5 ± 15.4 mL/min/1.73m 2 , and the prevalence of RD (defined as eGFR < 60 mL/min/1.73m2 ) was 6.3%. The prevalence of RD was 3.3% in the NP group, 10.2% in the CP group, 5.3% in the NCP group, and 14.5% in the MP group (P < 0.001 by ANOVA tests). The adjusted odds ratio for RD was 3.38 (95% confidence interval, 1.27 -9.04) for the MP group, compared with the NP group. The presence of RD showed an independent association with the MP counts (r = 0.155, P < 0.001); however, there was no association between RD and other plaque characteristics. In conclusion, RD is associated with MP rather than CP or NCP, compared with NP, which may reflect one of the developmental processes of CAD in patients with RD.

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