Prognostic value of calcium score and coronary flow velocity reserve in asymptomatic diabetic patients

Abstract

BackgroundThe risk stratification of patients with diabetes mellitus (DM) is a major objective for the clinicians, and it can be achieved by coronary flow velocity reserve (CFVR) or with coronary artery calcium score (CS). CS evaluates underlying coronary atherosclerotic plaque burden and CFVR estimates both presence of coronary artery stenosis and microvascular function. Consequently, CFVR may provide unique risk information beyond the extent of coronary atherosclerosis.AimOur aim is to assess joint prognostic value of CFVR and CS in asymptomatic DM patients.Materials and methodsWe prospectively included 200 asymptomatic patients (45,5 % male, mean age 57,35 ± 11,25), out of which, there were 101 asymptomatic patients with DM and 99 asymptomatic patients without DM, but with one or more conventionally risk factors for coronary artery disease. We analyzed clinical, biochemical, metabolic, inflammatory parameters, CS by Agatston method, transthoracic Doppler echocardiography CFVR of left anterior descending artery and echocardiographic parameters.ResultsTotal CS and CS LAD were significantly higher, while mean CFVR was lower in diabetics compared to the nondiabetics. During 1 year follow-up, 24 patients experienced cardio-vascular events (one cardiovascular death, two strokes, three myocardial infarctions, nine new onsets of unstable angina and nine myocardial revascularizations): 19 patients with DM and five non DM patients, (p = 0,003). Overall event free survival was significantly higher in non DM group, compared to the DM group (94,9 % vs. 81,2 %, p = 0,002 respectively), while the patients with CS ≥200 and CFVR <2 had the worst outcome during 1 year follow up in the whole study population as well as in the DM group. At multivariable analysis CFVR on LAD (HR 12.918, 95 % CI 3.865–43.177, p < 0.001) and total CS (HR 13.393, 95 % CI 1.675–107.119, p = 0.014) were independent prognostic predictors of adverse events in DM group of patients.ConclusionBoth CS and CFVR provide independent and complementary prognostic information in asymptomatic DM patients. When two parameters are analyzed together, the risk stratification ability improves, even when DM patients are analyzed together with non DM patients. As a result, DM patients with CS ≥200 and CFVR <2 had the worst outcome. Consequently, the use of two tests identified subset of patients who can derive the most benefit from the intensive prevention measures.

N-terminal pro-brain natriuretic peptide is related with coronary flow velocity reserve and diastolic dysfunction in patients with asymmetric hypertrophic cardiomyopathy

“…Transthoracic CFVR is a versatile, reproducible, and noninvasive tool for evaluation of microcirculation in the absence of epicardial stenosis [9,17,[24][25][26][27]. Reduced CFVR is an important phenomenon in HCM, since inadequate increase of myocardial blood flow on demand predisposes HCM patients to recurrent myocardial ischemia [9,16,[28][29][30][31][32].…”

Prognostic Value of Coronary Calcium Score in Asymptomatic Individuals: A Systematic Review

“…Higher NT-proBNP values were strongly predictive and associated with high CAC scores of CVD, where high NT-proBNP was associated with depressed systolic and diastolic function, while CAC correlated with atheromatous plaque formation. Dikic et al [ 58 ] found the association between coronary flow velocity reserve (CFRV) and CAC score in 200 asymptomatic and diabetic patients. In diabetic patients with a high CAC score, there was a significant correlation between CFRV and total CS compared to non-diabetics, where there was no such correlation.…”

“…The main findings and conclusions of the selected studies varied from each other; most of them agree that CAC was an excellent tool. In contrast, others believe that it was not always adequate [ 62 , 63 , 64 , 65 , 66 , 67 , 68 ] or evaluated if it was associated with other imaging methods or biomarkers [ 20 , 58 , 60 ] could suggest an inaccurate prognosis. Most of the studies indicated a strong correlation between the increase in the CAC score and the occurrence of cardiac events; in particular, the patients most at risk were those with CAC 400–1000 or >1000.…”

Evaluation of coronary calcium score in patients with normocalcemic primary hyperparathyroidism

“…In the current work, we measured the CCS, which has been recognized as a good predictor of cardiovascular disease in asymptomatic patients. 19 …”