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Coronary artery disease (CAD) extension-derived risk stratification for asymptomatic diabetic patients: usefulness of low-dose coronary computed tomography angiography (CCTA) in detecting high-risk profile patients

  • CARDIAC RADIOLOGY
  • Published:
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Abstract

Background

As one of the most frequent risk factors for cardiovascular disease, type 2 diabetes mellitus (T2DM) is one of the largest causes of death. However, an acute cardiac presentation is not uncommon in diabetic patients, and the current investigative approach remains often inadequate. The aim of our study was to retrospectively stratify the risk of asymptomatic T2DM patients using low-dose 640-slice coronary computed tomography angiography (CCTA).

Materials and methods

CCTA examinations of 62 patients (mean age, 65 years) with previous diagnosis of type 2 diabetes and without cardiac symptoms were analyzed. Image acquisition was performed using a 640-slice CT. Per-patient, per-vessel and per-plaque analyses were performed. Stratification risk was evaluated according to the ESC guidelines. The patients were followed up after 2.21 ± 0.56 years from CCTA examination.

Results

Coronary artery disease (CAD) was found in 58 patients (93.55%) presenting 290 plaques. Analysis of all samples showed severe-to-occlusive atherosclerosis in 24 patients (38.7% of cases). However, over the degree of stenosis, 23 patients were evaluated at high risk considering the extension of CAD. Good agreement was shown by the correlation of CAD extension/risk estimation and MACE incidence, according to a Kaplan–Meier survival analysis (p value = 0.001), with a 7.25-fold increased risk (HR 7.25 CI 2.13–24.7; p value = 0.002).

Conclusion

Our study confirms the high capability of CCTA to properly stratify the CV risk of asymptomatic T2DM patients. Its use could be recommended if we consider how current investigative strategies to correctly assess these patients often seem inadequate.

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Abbreviations

T2DM:

Type 2 diabetes mellitus

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

MACE:

Major adverse cardiac events

CHF:

Chronic heart failure

PCI:

Percutaneous coronary intervention

ECG:

Electrocardiogram 

AEC:

Automatic exposure control

SD:

Standard deviation

FOV:

Field of view

DLP:

Dose length product

MPR:

Multiplanar reconstruction

MIP:

Maximum intensity projection

VR:

Volume rendering

AHA:

American Heart Association

HU:

Hounsfield unit

ESC:

European Society of Cardiology

CS:

Calcium score

ANOVA:

Analysis of variance

LMA:

Left main artery

LDA:

Left descending artery

CX:

Circumflex artery

RCA:

Right coronary artery

ICA:

Invasive coronary angiography

OMT:

Optimal medical therapy

CABG:

Coronary artery bypass grafting

HR:

Hazard ratio

CV:

Cardiovascular

PET:

Positron emission tomography

CMR:

Cardiac magnetic resonance

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Acknowledgements

The authors wish to thank Angela Martella for the English revision manuscript.

Funding

No funding were obtained.

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Authors and Affiliations

  1. Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio 1, 67100, L’Aquila, Italy

    Pierpaolo Palumbo, Ester Cannizzaro, Federico Bruno, Maria Carmela De Donato, Camilla De Cataldo, Antonio Barile, Alessandra Splendiani & Carlo Masciocchi

  2. Radiology Department, Azienda Ospedaliero Universitaria “Ospedali Riuniti”, Via Conca 71, 60126, Ancona, Italy

    Nicolò Schicchi, Marco Fogante, Andrea Agostini & Andrea Giovagnoni

  3. Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100, L’Aquila, Italy

    Ernesto Di Cesare

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Correspondence to Pierpaolo Palumbo.

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Our retrospective study was carried out after approval obtained by the internal review board committee of our university.

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Palumbo, P., Cannizzaro, E., Bruno, F. et al. Coronary artery disease (CAD) extension-derived risk stratification for asymptomatic diabetic patients: usefulness of low-dose coronary computed tomography angiography (CCTA) in detecting high-risk profile patients. Radiol med 125, 1249–1259 (2020). https://doi.org/10.1007/s11547-020-01204-z

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