Use of imaging and clinical data to screen for cardiovascular disease in asymptomatic diabetics

Cardiovascular Diabetology

Original Investigation

Khurram Nasir¹  Timothy W. Churchill²  Ron Blankstein³  Edward Hulten³  Márcio S. Bittencourt⁴  Carlos Eduardo Rochitte⁵  Bernardo L. Wajchenberg⁵  Carlos A. Fernandes Tavares⁵  Antonio C. Lerario⁵  Mateus Guimaraes Fahel⁵  Augusto H. Uchida⁵  Fabricia P. O. Rassi⁵  Carlos Henrique Reis Esselin Rassi⁵ 

[1] Department of Cardiology, Baptist Health South Florida, 8900 N. Kendall Drive, 33176, Miami, FL, USA;Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, 02115, Boston, MA, USA;Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St, 02115, Boston, MA, USA;Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St, 02115, Boston, MA, USA;Center for Clinical and Epidemiological Research, Division of Internal Medicine, University Hospital, and State of São Paulo Cancer Institute (ICESP), University of São Paulo, São Paulo, Brazil;Heart Institute (InCor), University of São Paulo, Medical School, Brazil, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, 05403-000, São Paulo, SP, Brazil;

关键词: Type 2 diabetes mellitus;    Coronary artery disease;    Coronary computed tomography angiography;   

DOI  :  10.1186/s12933-016-0334-4

 received in 2015-09-16, accepted in 2016-01-13,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThere is increasing evidence to suggest that not all individuals with type 2 diabetes mellitus (T2DM) have equal risk for developing cardiovascular disease. We sought to compare the yield of testing for pre-clinical atherosclerosis with various approaches.Methods98 asymptomatic individuals with T2DM without known coronary artery disease (CAD) were enrolled in a prospective study and underwent carotid ultrasound, exercise treadmill testing (ETT), coronary artery calcium (CAC) scoring, and coronary computed tomography angiography (CTA).ResultsOf 98 subjects (average age 55 ± 6, 64 % female), 43 (44 %) had coronary plaque detectable on CTA, and 38 (39 %) had CAC score >0. By CTA, 16 (16 %) had coronary stenosis ≥50 %, including three subjects with CAC = 0. Subjects with coronary plaque had greater prevalence of carotid plaque (58 % vs. 38 %, p = 0.01) and greater carotid intima media thickness (0.80 ± 0.20 mm vs. 0.70 ± 0.11 mm, p = 0.02). Notably, 18 of 55 subjects (33 %) with normal CTA had carotid plaque. Eight subjects had a positive ETT, of whom five had ≥ 50 % coronary stenosis, two had <50 % stenosis, and one had no CAD. Among these tests, CAC scoring had the highest sensitivity and specificity for prediction of CAD.ConclusionAmong asymptomatic subjects with T2DM, a majority (56 %) had no CAD by CTA. When compared to CTA, CAC was the most accurate screening modality for detection of CAD, while ETT and carotid ultrasound were less sensitive and specific. However, 33 % of subjects with normal coronary CTA had carotid plaque, suggesting that screening for carotid plaque might better characterize stroke risk in such patients.

【 授权许可】

CC BY   
© Rassi et al. 2016