Coronary Computed Tomographic Angiographic Findings in Asymptomatic Patients With Type 2 Diabetes Mellitus

Park, Gyung‐Min; Lee, Seung-Whan; Cho, Young‐Rak; Kim, Chan Joon; Cho, Jung Sun; Park, Mahn‐Won; Her, Sung Ho; Ahn, Jung‐Min; Lee, Jong‐Young; Park, Duk‐Woo; Kang, Soo–Jin; Kim, Young‐Hak; Lee, Cheol Whan; Koh, Eun Hee; Lee, Woo Je; Kim, Min‐Seon; Lee, Ki‐Up; Kang, Joon‐Won; Lim, Tae‐Hwan; Park, Seong-Wook; Park, Seung‐Jung; Park, Joong‐Yeol

doi:10.1016/j.amjcard.2013.11.028

Cited by 44 publications

(37 citation statements)

References 29 publications

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“…In the follow-up period (33.7 ± 7.8 months), those with significant CAD showed more cardiac events (7.1% vs 0.5%) and lower 3-year event-free survival rates (99.2 ± 0.6% vs 90.9 ± 2.6%, p <0.001). [52] Min et al identified 400 asymptomatic diabetic patients without known CAD from CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. They assessed major adverse cardiovascular events (MACE) -inclusive of mortality, nonfatal myocardial infarction (MI), and late target vessel revascularization ≥90 days.…”

Section: Coronary Computed Tomographic Angiography and Cardiovascularmentioning

confidence: 99%

Imaging Atherosclerosis in Diabetes: Current State

2016

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(310) 222-4107 mbudoff@labiomed.org Fax (310) 782-9652This work was supported and funded by American Diabetes Association (ADA) with grant reference of 7-12-CT-08. 1 AbstractPrevalence of diabetes mellitus is rapidly increasing worldwide. Disease is an independent and important risk factor for cardiovascular disease in both men and women. Cardiovascular events including myocardial infarction and stroke are the primary causes of mortality in both type 1 and type 2 diabetes. Affected patients frequently have asymptomatic coronary artery disease.Studies have shown heterogeneity in cardiovascular risk among patients with diabetes. Imaging can help categorize patients based on their risk of future cardiovascular events by identifying those patients with atherosclerosis, rather than just relying on risk prediction based on population based studies. In this article we will review the evidence regarding use of atherosclerosis imaging in patients with diabetes.2

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Section: Coronary Computed Tomographic Angiography and Cardiovascularmentioning

confidence: 99%

Imaging Atherosclerosis in Diabetes: Current State

2016

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“…An implantable intracardiac ischemia detection device confirmed acute coronary syndrome in 4 patients 13. Approximately one‐third of the asymptomatic patients with type 2 diabetes mellitus had significant CAD on coronary computed tomography angiography with a subsequent high risk for cardiac events 14. In our study, most of the patients did not have any chest pain (only one patient experienced chest pain) despite having ischemia, possibly as a result of the MPI or CAG.…”

Section: Discussionmentioning

confidence: 45%

Continuous ST‐Monitoring Function of Implantable Cardioverter Defibrillator Detects Silent Ischemia in Patients With Coronary Artery Disease

Watanabe¹,

Hirooka

Furukawa

et al. 2018

JAHA

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BackgroundNewer implantable cardioverter defibrillators can monitor intracardiac ECGs , but their ability to detect ischemia is unclear. This study investigated the usefulness of implantable cardioverter defibrillators with an ST‐monitoring function in coronary artery disease patients.Methods and ResultsWe conducted a prospective study of implantable cardioverter defibrillator patients with the ST‐monitoring function. One hundred seventy‐three patients who received implantable cardioverter defibrillators for primary or secondary prevention of sudden cardiac death. All patients underwent medical examinations at least every 6 months, with standard 12‐lead ECGs and device checks that included analysis of the ST‐monitoring function. Myocardial perfusion imaging or coronary angiography was performed during the follow‐up. The mean follow‐up duration was 23.3±7.7 months. Significant ST changes occurred in 15 patients (8.7%), of whom 14 were asymptomatic. The incidence of angina pectoris was significantly higher in the ST change (+) group than that in the ST change (−) group (28.6% versus 7.2%, P=0.03). In the patients who underwent myocardial perfusion imaging, the sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to detect ischemia were 75.0%, 72.5%, and 93.5%, respectively. The sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to predict residual stenosis evaluated using coronary angiography were 76.9%, 83.5%, and 97.5%, respectively. The percentage of patients with a septal right ventricular lead was significantly lower in the ST change (+) group than in the ST change (−) group (13.5% versus 33.5%, P=0.01).ConclusionsIf intracardiac ECGs ST changes are detected, it is necessary to use additional modalities even in asymptomatic patients.Clinical Trial RegistrationURL: http://upload.umin.ac.jp. Unique identifier: UMIN000011824.

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“…Despite the youth of the modality, the use of coronary CTA in asymptomatic patients with diabetes has already been reported in numerous studies. 16,17 The overall conclusion from these studies is that the findings from CTA are heterogeneous and include both (1) patients with diabetes who have a high prevalence of coronary atherosclerosis, obstructive CAD, and higher prevalence of adverse plaque features compared to non-diabetic subjects, while (2) a substantial proportion of these patients have entirely normal coronary CTA with no evidence of atherosclerotic plaque.…”

Section: Coronary Ct Angiographymentioning

confidence: 99%

“…Eight prior studies reported both CAC (including the CAC 0) categories and coronary plaque as seen on coronary CTA in asymptomatic diabetic. [16][17][18][19][20][21][22][23] Of 1747 patients in these studies, 38% (659 patients) had CAC 0-an identical percentage to that seen in the MESA study. On coronary CTA, 26% (455 patients) had entirely normal studies-i.e., no non-calcified or calcified plaque.…”

Section: Prevalence Of Coronary Atherosclerosis and Any Plaque On Cormentioning

confidence: 99%

“…Park et al followed 557 asymptomatic diabetic Korean patients after coronary CTA for cardiac events, including cardiac death, nonfatal MI, acute coronary syndromes, and late revascularization. 17 Atherosclerosis was observed in 71% of the patients, of whom 31% had significant ([50%) stenosis, and 17% had significant stenosis in the LM or proximal LAD. During a mean follow-up of 34 months, the prognosis was excellent for patients without atherosclerosis (0.5% total event rate).…”

Section: Prediction Of Cardiac Eventsmentioning

confidence: 99%

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