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Liu Q, Qiu J, Sun S, Wang X, Sun Z, Zhao H. Coronary computed tomography angiography as a screening tool for moderate-high risk asymptomatic type 2 diabetes mellitus patients. Front Cardiovasc Med 2022; 9:974294. [PMID: 36017086 PMCID: PMC9395582 DOI: 10.3389/fcvm.2022.974294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background There are few data on the clinical significance of coronary computed tomography angiography (CCTA) in asymptomatic type 2 diabetes mellitus (T2DM) patients. We performed a retrospective study to evaluate coronary heart disease (CHD) screening in asymptomatic patients with T2DM using CCTA and CHD risk stratification prediction. Materials and methods Data from 141 T2DM patients (58 ± 8 years, 57% males) without known symptoms suggestive of CHD who underwent CCTA were retrospectively analyzed. The patients were classified into three subgroups based on United Kingdom prospective diabetes study (UKPDS) CHD risk stratification prediction. Seventy-four patients without diabetes mellitus and CHD who underwent CCTA successively were chosen as the control group. The segment involvement score (SIS), segment stenosis score (SSS), stenosis coefficient (SC), severe proximal plaque (SPP) positive ratio and CCTA-adapted Leaman score (CT-LeSc) based on CCTA data were evaluated and compared among the groups. Results Compared with the patients in the control group, patients in the moderate-high risk DM groups had higher scores on the SIS, SSS, SC, CT-LeSc, and a higher SPP positive ratio (all p-values < 0.001), and no difference was observed between the low-risk group and the control group (p = 0.136, p = 0.088, p = 0.0.067, p = 0.225, p = 1.000, respectively). Compared with patients in the control group, the patients in the moderate-high risk DM groups had increased odds of SIS > 3 [odds ratio (OR) = 6.557, p < 0.001; OR = 4.455, p < 0.001, respectively], SSS > 5 (OR = 5.727, p < 0.001; OR = 5.144, p < 0.001, respectively), CT-LeSc > 8.7 (OR = 3.780, p = 0.001; OR = 2.804, p = 0.007, respectively), and obstructive stenosis (OR = 7.233, p < 0.001; OR = 5.787, p < 0.001, respectively). Conclusion The moderate-high CHD risk patients had increased odds of obstructive coronary artery stenosis, and the distribution of coronary artery stenosis was more extensive and more severe in that group compared to the patients without diabetes mellitus and CHD. CHD can be effectively screened in moderate-high risk asymptomatic T2DM patients using CCTA.
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Affiliation(s)
- Qiaolu Liu
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an, China
- The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
- Shandong Engineering Laboratory, Medical Imaging and Quantitative Analysis, Tai’an, China
| | - Shuxin Sun
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an, China
- The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
- Shandong Engineering Laboratory, Medical Imaging and Quantitative Analysis, Tai’an, China
| | - Xiaoqiang Wang
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhanguo Sun
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
- Zhanguo Sun,
| | - Huihui Zhao
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an, China
- The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
- Shandong Engineering Laboratory, Medical Imaging and Quantitative Analysis, Tai’an, China
- *Correspondence: Huihui Zhao,
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Tian P, Zheng X, Li M, Li W, Niu Q. Long-term prognostic value of coronary computed tomography angiography for asymptomatic patients with CAD in type 2 diabetes mellitus. Exp Ther Med 2019; 18:747-754. [PMID: 31258710 DOI: 10.3892/etm.2019.7593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 01/18/2019] [Indexed: 11/06/2022] Open
Abstract
The present study was performed to investigate the prognostic value of coronary computed tomography angiography (CTA) results for asymptomatic patients with coronary artery disease (CAD) in type 2 diabetes mellitus (T2DM). A total of 164 asymptomatic patients with T2DM were enrolled at Weifang Traditional Chinese Hospital (Weifang, China). Coronary plaques and stenosis severity were evaluated after CTA. Structures >1 mm2 adjacent to or within the coronary artery lumen that could be clearly separated from the vessel lumen, was scored as a coronary plaque. Stenosis of ≥50% was considered as being obstructive. CAD was defined as the presence of any coronary plaque or a coronary artery calcium (CAC) score of >0. A CAC score of 0 and no coronary plaques was considered to indicate the absence of CAD. A 5-year follow-up was performed to determine the impact of the CTA findings and various clinicopathological characteristics on the prognosis of all participants. The primary end-point was any cardiac event. Event-free survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. Based on the coronary CTA results, the patients were classified into 3 groups according to the extent of stenosis: Normal coronary arteries, obstructive CAD and non-obstructive CAD. Significant differences in 5-year event-free survival were identified among the groups with normal coronary arteries, non-obstructive CAD and obstructive CAD (P=0.026). Further analysis indicated that the event-free survival rate of patients with 1-vessel CAD was 94.11%, that of patients with 2-vessel CAD was 73.68% and that associated with 3-vessel CAD was 61.54%. Multivariate Cox regression analysis revealed that non-obstructive as well as obstructive CAD diagnosed by coronary CTA are prognostic indicators for asymptomatic T2DM patients [hazard ratio (HR)=11.132, 95% confidence interval (CI): 1.857-66.742, P=0.008; HR=7.792, 95% CI: 1.750-34.698, P=0.007, respectively]. In conclusion, the present study suggests that coronary CTA may predict the prognosis of asymptomatic patients with T2DM.
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Affiliation(s)
- Peigang Tian
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Xiangyang Zheng
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Mingzhi Li
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Weiwei Li
- Department of Radiology, Tai'an Central Hospital Branch, Tai'an, Shandong 271000, P.R. China
| | - Qingliang Niu
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
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Beller E, Meinel FG, Schoeppe F, Kunz WG, Thierfelder KM, Hausleiter J, Bamberg F, Schoepf UJ, Hoffmann VS. Predictive value of coronary computed tomography angiography in asymptomatic individuals with diabetes mellitus: Systematic review and meta-analysis. J Cardiovasc Comput Tomogr 2018; 12:320-328. [PMID: 29685675 DOI: 10.1016/j.jcct.2018.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/31/2018] [Accepted: 04/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Coronary CT angiography (CTA) is generally not established as a screening tool for asymptomatic individuals. However, it is controversial whether this test may have a role for screening asymptomatic individuals with diabetes mellitus (DM) due to the high prevalence of asymptomatic coronary artery disease (CAD) in this subgroup. METHODS We searched PubMed and EMBASE through May 2017 for studies that reported on the association between findings at coronary CTA and future cardiac events in asymptomatic individuals with DM. Summary hazard ratios for the presence of obstructive CAD (≥50% stenosis), presence of non-obstructive plaque (<50% stenosis), segment involvement score, and segment stenosis score were derived using a random effects regression model. I2 was calculated to quantify between-study heterogeneity and causing factors were identified using meta-regression. RESULTS A total of 10 studies reporting on 5012 individuals with DM (median age: 62.3 years, median proportion of women: 40.5%) were included in the analysis. The presence of obstructive CAD on coronary CTA (vs. non-obstructive or no CAD) was associated with a significantly elevated risk for adverse events (summary HR: 4.07, 95% CI: 2.30 to 7.21). The estimated summary HR for non-obstructive plaque (vs. no CAD) was 2.17 (95% CI: 1.11 to 4.25). The pooled HRs per unit for segment stenosis score and segment involvement score were 1.44 (95% CI: 0.98 to 2.12), and 1.73 (95% CI: 1.07 to 2.80) respectively. On meta-regression analysis, we observed a trend towards a higher risk estimate in studies with a higher proportion of females (p = 0.1063). CONCLUSION The presence and extent of CAD on coronary CTA are strong, independent predictors of cardiovascular events in asymptomatic individuals with DM despite heterogeneity between studies in endpoints, study population and length of follow-up.
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Affiliation(s)
- Ebba Beller
- Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany
| | - Felix G Meinel
- Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany.
| | | | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Germany
| | - Kolja M Thierfelder
- Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians University, Munich, Germany
| | - Fabian Bamberg
- Department of Radiology, University of Tübingen, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Verena S Hoffmann
- Institute of Biomedical Informatics, Biometry and Epidemiology, Ludwig Maximilians University, Munich, Germany; Department of Infectious Diseases & Tropical Medicine, Ludwig-Maximilians University, Germany
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Shahi N, Tobe SW. Thresholds and Targets for Hypertension Management in Adults With Type 2 Diabetes Should Remain at 130/80 mmHg: What's the Evidence? Can J Diabetes 2017; 42:166-172. [PMID: 29273294 DOI: 10.1016/j.jcjd.2017.10.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
Hypertension and diabetes are common comorbidities and are both modifiable risk factors for cardiovascular disease and death. Lowering blood pressure reduces target organ damage and prevents cardiovascular disease outcomes. The harmonized Canadian clinical practice guidelines for managing hypertension in people with diabetes provides health-behaviour advice and medical therapy recommendations for a threshold blood pressure of 130/80 mmHg and above and to target blood pressure to below 130/80 mmHg. We have reviewed the studies supporting these recommendations and others, and they appear to be at odds with the guidelines, including those for elderly people and patients with pre-existing cardiovascular disease.
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Affiliation(s)
- Niharika Shahi
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Sheldon W Tobe
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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Budoff MJ, Raggi P, Beller GA, Berman DS, Druz RS, Malik S, Rigolin VH, Weigold WG, Soman P. Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient: The Imaging Council of the American College of Cardiology. JACC Cardiovasc Imaging 2016; 9:176-92. [PMID: 26846937 DOI: 10.1016/j.jcmg.2015.11.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/06/2015] [Indexed: 12/21/2022]
Abstract
Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a "coronary risk equivalent," implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies from different cohorts provided varying conclusions on the validity of the concept of coronary risk equivalency in patients with diabetes. New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk. Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment. The Imaging Council of the American College of Cardiology systematically reviewed all modalities commonly used for risk stratification in persons with diabetes mellitus and summarized the data and recommendations. This document reviews the evidence regarding the use of noninvasive testing to stratify asymptomatic patients with diabetes with regard to coronary heart disease risk and develops an algorithm for screening based on available data.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California.
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - George A Beller
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center and the Cedars-Sinai Heart Institute, Los Angeles, California
| | - Regina S Druz
- Department of Cardiology, Hofstra North Shore-LIJ School of Medicine, Uniondale, New York
| | - Shaista Malik
- Department of Medicine, University of California, Irvine, California
| | - Vera H Rigolin
- Department of Medicine/Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wm Guy Weigold
- Cardiology Division, MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Prem Soman
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification: The CORE320 study. Int J Cardiol 2015; 201:570-7. [DOI: 10.1016/j.ijcard.2015.05.110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/13/2015] [Accepted: 05/14/2015] [Indexed: 11/20/2022]
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Improving the diagnostic performance of the real world coronary computed tomography angiography including uninterpretable segments. Int J Cardiol 2014; 176:975-9. [DOI: 10.1016/j.ijcard.2014.08.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/07/2014] [Accepted: 08/21/2014] [Indexed: 11/23/2022]
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Carotid intima media thickness and coronary atherosclerosis linkage in symptomatic intermediate risk patients evaluated by coronary computed tomography angiography. Int J Cardiol 2014; 176:988-93. [PMID: 25213576 DOI: 10.1016/j.ijcard.2014.08.141] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/22/2014] [Accepted: 08/26/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is a growing evidence that carotid intima media thickness (CIMT) is associated with coronary artery disease (CAD) and it should be used as a predictor of atherosclerotic burden of coronary arteries. However, these studies have been performed by using invasive coronary angiography (ICA) and in high-risk patients for CAD. The purpose of this study was to evaluate the correlation between CIMT by ultrasound and coronary atherosclerosis in symptomatic intermediate risk patients by coronary computed tomography angiography (CCTA). METHODS We enrolled 204 consecutive symptomatic patients (mean age: 61±10; men: 118) and intermediate risk for CAD. All patients underwent CIMT ultrasound evaluation and CCTA. Coronary artery calcium score (CACS), characteristics of plaques, severity of CAD, segment involvement score (SIS) and Gensini's score were assessed and compared with CIMT values. RESULTS CIMT has been proved as an independent predictor of a number of coronary artery plaques, overall number of mixed and remodeled plaques, presence of obstructive CAD, high SIS and Gensini's score (HR 1.2, CI 1.05-1.42, p 0.01; HR 1.2, CI 1.01-1.41, p 0.03; HR 9.0, CI 1.37-59.7, p 0.02; HR 21.0, CI 2.40-184, p<0.01; HR 1.2, CI 1.08-1.42, p<0.01; HR 1.2, CI 1.08-1.42, p<0.01, respectively). A cut-off value>1.3 was associated with a better positive and negative predictive value (100% and 69%) to predict the combined endpoint of presence and mixed and/or remodeled coronary artery plaques. CONCLUSIONS CIMT is an independent predictor of coronary atherosclerotic burden as detected by CCTA in symptomatic intermediate risk patients.
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