8
|
Dikic M, Tesic M, Markovic Z, Giga V, Djordjevic-Dikic A, Stepanovic J, Beleslin B, Jovanovic I, Mladenovic A, Seferovic J, Ostojic M, Arandjelovic A. Prognostic value of calcium score and coronary flow velocity reserve in asymptomatic diabetic patients. Cardiovasc Ultrasound 2015; 13:41. [PMID: 26340922 PMCID: PMC4560883 DOI: 10.1186/s12947-015-0035-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/02/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The 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. AIM Our aim is to assess joint prognostic value of CFVR and CS in asymptomatic DM patients. MATERIALS AND METHODS We 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. RESULTS Total 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. CONCLUSION Both 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.
Collapse
Affiliation(s)
- Miodrag Dikic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia.
| | - Milorad Tesic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia.
| | - Zeljko Markovic
- Medical School, University of Belgrade, Belgrade, Serbia. .,Clinic for Radiology, Clinical Center of Serbia, Belgrade, Serbia.
| | - Vojislav Giga
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia. .,Medical School, University of Belgrade, Belgrade, Serbia.
| | - Ana Djordjevic-Dikic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia. .,Medical School, University of Belgrade, Belgrade, Serbia.
| | - Jelena Stepanovic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia. .,Medical School, University of Belgrade, Belgrade, Serbia.
| | - Branko Beleslin
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia. .,Medical School, University of Belgrade, Belgrade, Serbia.
| | - Ivana Jovanovic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia.
| | - Ana Mladenovic
- Clinic for Radiology, Clinical Center of Serbia, Belgrade, Serbia.
| | - Jelena Seferovic
- Medical School, University of Belgrade, Belgrade, Serbia. .,Clinic for Endocrinology, Clinical Center of Serbia, Belgrade, Serbia.
| | | | - Aleksandra Arandjelovic
- Medical School, University of Belgrade, Belgrade, Serbia. .,Cardiology Department, Clinical Hospital Zvezdara, Belgrade, Serbia.
| |
Collapse
|
10
|
Jovanovic I, Giga V, Tesic M, Paunovic I, Kostic J, Dobric M, Dikic M, Stepanovic J, Belesiln B, Djordjevic-Dikic A, Lindqvist P, Henein M, Soderberg S, Gonzalez M, Tossavainen E, Djordjevic-Dikic A, Tesic M, Stepanovic J, Giga V, Kostic J, Trifunovic D, Jovanovic I, Paunovic I, Stanic S, Beleslin B, Koutsogiannis N, Moulias A, Xanthopoulou I, Mavronasiou E, Kakkavas A, Davlouros P, Alexopoulos D, Barbier P, Cefalu' C, Gripari P, Pontone G, Andreini D, Pepi M, Duncan AM, Snow T, Barker S, Davies S, Di Mario C, Moat N, Serra W, Chetta A, Marangio E, Reverberi C, Cattabiani MA, Ardissino D, Sahlen A, Hakansson F, Shahgaldi K, Manouras A, Norman M, Winter R, Johnson J, Fawzi S, Rafla SM, El Atroush H, Farouk K, Wilson C, Hilde J, Skjoerten I, Melsom M, Humerfelt S, Hansteen V, Hisdal J, Steine K, Rees P, Hutchings S, Magnino C, Omede' P, Avenatti E, Chiarlo M, Presutti D, Bucca C, Moretti C, Gaita F, Veglio F, Milan A, Kostic J, Tesic M, Stepanovic J, Giga V, Paunovic I, Marinkovic A, Jovanovic I, Beleslin B, Ostojic M, Djordjevic Dikic A, Najjar E, Winter R, Gunyeli E, Shahgaldi K, Manouras A, Rodriguez Munoz DA, Moya Mur J, Baguda JDJ, Lazaro Rivera C, Navas Tejedor P, Jimenez Nacher J, Castillo Orive M, Fernandez-Golfin C, Zamorano Gomez J, Satendra M, Sargento L, Sousa C, Lousada N, Palma Reis R, Said K, Shehata A, Ashour Z, El-Tobgi S, Li Kam Wa M, Pabari P, Perry S, Kyriacou A, Manisty C, Francis D, Kusmierczyk-Droszcz B, Kowalik E, Niewiadomska J, Lech A, Hoffman P, Patrianakos A, Kalogerakis A, Zacharaki A, Nyktari E, Psathakis E, Parthenakis F, Vardas P, Stefani L, Milicia M, Bartolini A, Gori N, Tempesti G, Toncelli L, Vono M, Di Tante V, Pedri S, Galanti G, Zhong L, Huang F, Le T, Chen Q, Gao F, Tan R, Anwar A, Nosir Y, Alasnig M, Llemit M, Alhagoly A, Chamsi-Pasha H, Trifunovic D, Ostojic M, Stankovic S, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Beleslin B, Djordjevic-Dikic A, Banovic M, Tesic M, Orii M, Hirata K, Tanimoto T, Ishibashi K, Yamano T, Ino Y, Yamaguchi T, Kubo T, Imanishi T, Akasaka T, Giesecke A, Ripsweden J, Shahgaldi K, Guyeli E, Winter R, Hristova K, Vasilev D, Pavlov P, Katova T, Simova I, Kostova V, Wada T, Hirata KH, Kubo T, Shiono Y, Ishibashi K, Tanimoto T, Ino Y, Yamaguchi T, Imanishi TI, Akasaka T, Martirosyan M, Adamyan K, Chilingaryan A, Negrea S, Alexandrescu C, Civaia F, Bourlon F, Dreyfus G, Malev E, Kim G, Omelchenko M, Mitrofanova L, Zemtsovsky E, Santoro A, Costantino F, Dores E, Tarsia G, Di Natale M, Innelli P, Schiano Lomoriello V, De Stefano F, Galderisi M, Lee SP, Ahn H, Hwang H, Kim H, Kim Y, Kim K, Kim K, Sohn D, Ahn H, Calin A, Popescu B, Rosca M, Beladan C, Enache R, Gurzun M, Calinescu C, Calin C, Ginghina C, Rafla S, Hamdy S, Lotfi M, Elneklawy M, Mordi I, Spratt J, Sonecki P, Stanton T, Mcculloch A, Goodfield N, Tzemos N, Ghulam Ali S, Fusini L, Tamborini G, Celeste F, Gripari P, Muratori M, Maffessanti F, Mirea O, Alamanni F, Pepi M, Demirkan B, Guray Y, Guray U, Ege M, Kisacik H, Sasmaz H, Korkmaz S, Petrovic-Nagorni S, Zdravkovic-Ciric S, Nagorni A, Stanojevic D, Jankovic-Tomasevic R, Atanaskovic V, Mitic V, Szymanski C, Magne J, Rusinaru D, Fournier A, Mezghani S, Peltier M, Touati G, Tribouilloy C, Huttin O, Khachab H, Voilliot D, Schwartz J, Zinzius P, Lemoine S, Carillo S, Popovic B, Juilliere Y, Selton-Suty C, Kimura K, Takenaka K, Ebihara A, Uno K, Morita H, Nakajima T, Motoyoshi Y, Komori T, Yatomi Y, Nagai R, Mihaila S, Mincu R, Rimbas R, Badiu C, Vinereanu D, Igual Munoz B, Maceira Gonzalez A, Domingo Valero D, Estornell Erill J, Giner Blasco J, Arnau Vives M, Molina Aguilar P, Navarro Manchon J, Zorio Grima E, Miglioranza M, Sant'anna R, Rover M, Mantovani A, Lessa J, Haertel J, Salgado Filho P, Kalil R, Leiria T, Risum N, Sogaard P, Fritz Hansen T, Bruun N, Kisslo J, Velazquez E, Jons C, Olsen N, Azevedo O, Lourenco M, Machado I, Pereira V, Medeiros R, Pereira A, Quelhas I, Lourenco A, Rangel I, Goncalves A, Sousa C, Correia A, Pinho T, Madureira A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Kinova E, Zlatareva N, Goudev A, Rogge B, Cramariuc D, Lonnebakken M, Rieck A, Gohlke-Baerwolf C, Chambers J, Boman K, Gerdts E, Florescu M, Mihalcea D, Enescu O, Suran B, Mincu R, Patrascu N, Magda L, Cinteza M, Vinereanu D, Bruno R, Cogo A, Bartesaghi M, Thapa K, Duo E, Basnyat B, Ghiadoni L, Picano E, Sicari R, Pratali L, Jensen-Urstad K, Nordin A, Bjornadal L, Svenungsson E, King GJ, Murphy R, Almuntaser I, Mc Loughlin B, Livingston A, Nevin S, Clarke J, De Sousa CC, Rangel I, Martins E, Correia A, Nadais G, Silveira F, Silva Cardoso J, Goncalves A, Macedo F, Maciel M, Lindqvist P, Henein M, Hornsten R, Rasmunsson J, Hedstrom M, Alm C, Filali T, Jedaida B, Lahidheb D, Gommidh M, Mahfoudhi H, Hajlaoui N, Dahmani R, Fehri W, Haouala H, Shin SH, Woo S, Kim D, Park K, Kwan J, Brambila CA, Gabrielli L, Bijnens B, Marin J, Sitges I, Grazioli G, Pare C, Mont L, Brugada J, Sitges M, Pica S, Ghio S, Raineri C, Camporotondo R, Rordorf R, Previtali M, Landolina M, Valentini A, Turco A, Visconti L, Stuart B, Santos A, Cruz I, Caldeira D, Cotrim C, Fazendas P, Joao I, Almeida A, Pereira H, Goncalves A, Pinho T, Sousa C, Rangel I, Correia A, Madureira A, Macedo F, Zamorano JL, Maciel M, Driessen M, Kort E, Leiner T, Cramer M, Sieswerda G, Chamuleau S, Kim D, Choi Y, Park H, Kim H, Shin J, Song J, Kang D, Song J, Parisi V, Galasso G, Festa G, Piccolo R, Rengo G, De Rosa R, Pagano G, Iacotucci P, Leosco D, Piscione F, Bellsham-Revell H, Nedjati-Gilani S, Yao C, Pushparajah K, Penney G, Simpson J, Lopez Melgar B, Sanchez Sanchez V, Rodriguez Garcia J, Coma Samartin R, Martin Asenjo R, Fernandez Casares S, Lopez-Guarch CJ, Diaz Anton B, Mayordomo Gomez S, Lombera Romero F, Yamada S, Okada K, Iwano H, Nishino H, Nakabachi M, Yokoyama S, Kaga S, Mikami T, Tsutsui H, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Klitsie L, Roest A, Kuipers I, Van Der Hulst A, Hazekamp M, Blom N, Ten Harkel A, Hagendorff A, Stoebe S, Tarr A, Gelbrich G, Loeffler M, Pfeiffer D, Badran H, Elnoamany M, Soltan G, Ezat M, Elsedi M, Abdelfatah R, Yacoub M, Kydd A, Khan F, Mccormick L, Gopalan D, Virdee M, Dutka D, Ruiz Ortiz M, Mesa D, Delgado M, Romo E, Morenate M, Baeza F, Castillo F, Lopez Granados A, Del Prado JA, De Lezo JS, Kilickiran Avci B, Yurdakul S, Sahin S, Ermis E, Dilekci B, Aytekin S, Turhan S, Gerede D, Hural R, Ozcan O, Candemir B, Erol C, Saha SK, Kiotsekoglou A, Gopal A, Govind S, Lindqvist P, Soderberg S, Kawata T, Daimon M, Sekita G, Miyazaki S, Ichikawa R, Maruyama M, Suzuki H, Daida H, Persic V, Lovric D, Jurin H, Pehar Pejcinovic V, Baricevic Z, Pezo Nikolic B, Ivanac Vranesic I, Separovic Hanzevacki J, Ahn H, Cho G, Lee S, Kim H, Kim Y, Sohn D, Igual Munoz B, Estornell Erill J, Gonzalez AM, Bel Minguez A, Perez Guillen M, Donate Bertolin L, Monmeneu Menadas J, Lopez Lereu P, La Huerta AA, Argudo AM, Igual Munoz B, Gonzalez AM, Valero DD, La Huerta AA, Fernandez PA, Ferrer JM, Rueda Soriano J, Buendia Sanchez F, Estornell Erill J, Carrasco J, Carvalho MS, De Araujo Goncalves P, Sousa P, Dores H, Marques H, Pereira Machado F, Gaspar A, Aleixo A, Mota Carmo M, Roquette J, Vassiliadis IV, Despotopoulos E, Kaitozis O, Tekedis C, Al-Mallah M, Nour K, Tomaszewski A, Kutarski A, Brzozowski W, Tomaszewski M, Oleszczak K, Tong J, Bian Y, Yang F, Li P, Chen L, Shen X, Xu Y, Yan L, Kilickiran Avci B, Yurdakul S, Sahin S, Ermis E, Dilekci B, Aytekin S, Hristova K, Marinov R, Georgiev S, Kaneva A, Lasarov S, Mitev P, Katova T, Pilosoff V, Ikonomidis I, Tzortzis S, Triantafyllidi H, Paraskevaidis I, Trivilou P, Papadakis I, Papadopoulos C, Pavlidis G, Anastasiou-Nana M, Lekakis J. Poster session: Aortic stenosis. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|