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

Abstract

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...

Presence, Characteristics, and Volumes of Coronary Plaque Determined by Computed Tomography Angiography in Young Type 2 Diabetes Mellitus

“…Several studies showed that zero CAC could not rule out the presence of CAD. 23,24 In our population with a zero Agatston score, diabetic patients had a threefold higher prevalence of noncalcified plaque compared with nondiabetic patients (Figure 2).…”

Imaging Atherosclerosis in Diabetes: Current State

“…Kamimura et al evaluated 120 consecutive diabetic patients (75% male, mean age 65) by CCTA. Significant stenosis (defined as coronary artery stenosis > 70%) was present in 5% of patients whose CAC score = 0 [47]. Min et al showed that nearly one third of asymptomatic diabetics with a CAC score of zero indeed have atherosclerosis, and that over 10% of these individuals have obstructive CAD by CCTA.…”

Difference of coronary artery disease severity, extent and plaque characteristics between patients with hypertension, diabetes mellitus or dyslipidemia

“…Hypertension (HT), diabetes mellitus (DM) and dyslipidemia (DL) have been identified as risk factors for coronary artery disease (CAD) or the progression of vulnerable plaques [1][2][3][4]. Rupture of vulnerable plaques followed by severe stenosis of coronary arteries result in acute coronary syndrome [2].…”