Type 2 diabetes is associated with more advanced coronary atherosclerosis on multislice computed tomography and virtual histology intravascular ultrasound

Abstract

Background. Data on coronary plaque observations on multi-slice computed tomography (MSCT) in patients with type 2 diabetes are scarce.Methods and Results. In total, 60 patients (19 with diabetes) underwent 64-slice MSCT, followed by conventional coronary angiography with intravascular ultrasound (IVUS). Noninvasively, the extent of coronary atherosclerosis and 3 plaque types (non-calcified, calcified, mixed) were visually evaluated on MSCT. Invasively, plaque burden was assessed on gray-scale IVUS. Plaque composition was evaluated on virtual histology intravascular ultrasound (VH IVUS). Concerning geometrical plaque data, diabetic patients showed more plaques on MSCT (7.1 ± 3.2 vs 4.9 ± 3.2 in non-diabetic patients, P = .01). On gray-scale IVUS, diabetes was associated with a larger plaque burden (48.7 ± 10.7% vs 40.0 ± 12.1%, P = .003). Concerning plaque composition, diabetes was associated with more calcified plaques on MSCT (52% vs 24%). Relatively more fibrocalcific plaques in diabetic patients (29% versus 9%) were observed on VH IVUS. Moreover, these plaques contained more necrotic core (10.8 ± 5.9% vs 8.6 ± 5.2%, P = .01).Conclusion. A higher plaque extent and more calcified lesions were observed in diabetic patients on MSCT. The findings were confirmed on gray-scale and VH IVUS. Thus, MSCT may potentially be used to explore patterns of coronary atherosclerosis in diabetic patients. (J Nucl Cardiol 2009;16:376-83.)

Accuracy of 64-slice multidetector computed tomography for classification and quantitation of coronary plaque: Comparison with integrated backscatter intravascular ultrasound

“…MDCT tended to overestimate the volume of calcified plaque compared with that determined by IB-IVUS in the present study. Similar findings were reported by Pundziute et al who investigated coronary plaque composition on multi-slice CT and VH-IVUS in patients with diabetes [27]. The overestimation of plaque volume by MDCT was reported in another previous study and was attributed to a "partial volume effect" that makes it difficult to determine precisely the volume of calcified plaque [28].…”

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults

“…405 Seventy percent had coronary luminal narrowing of 1 or more coronary arteries on multislice CT coronary angiography, patients with diabetes showed more plaques on multislice CT than patients without diabetes (7.1Ϯ3.2 versus 4.9Ϯ3.2; Pϭ0.01) with more calcified plaques (52% versus 24%). 406 On invasive grayscale intravascular ultrasound, patients with diabetes in this study had a larger plaque burden (48.7%Ϯ10.7% versus 40.0%Ϯ12.1%; Pϭ0.03). Asymptomatic patients with diabetes have more coronary calcification than patients without diabetes even when controlling for other variables, [407][408][409] and for every increase in CAC on CT scanning, mortality for patients with diabetes is higher than in patients without diabetes.…”

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults

“…In another study by this group, 60% of asymptomatic patients with diabetes had evidence of coronary calcification, of which 18% had calcium scores of Ͼ400 (405). Seventy percent had coronary luminal narrowing of 1 or more coronary arteries on multislice CT coronary angiography, patients with diabetes showed more plaques on multislice CT than patients without diabetes (7.1Ϯ3.2 versus 4.9Ϯ3.2; pϭ0.01) with more calcified plaques (52% versus 24%) (406). On invasive grayscale intravascular ultrasound, patients with diabetes in this study had a larger plaque burden (48.7%Ϯ10.7% versus 40.0%Ϯ12.1%; pϭ0.03).…”