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

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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). Non-invasively, 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.

Section snippets

Patients and Study Protocol

A total of 60 patients, 19 (32%) patients with type 2 diabetes and 41 (68%) patients without diabetes, were included in the study. All patients presented with chest pain suggestive of CAD. Diabetes was diagnosed according to the criteria as set by the American Diabetes Association:9 (1) a fasting plasma glucose level of ≥7.0 mmol/L or (2) symptoms of diabetes and a casual plasma glucose level of ≥11.1 mmol/L. The patients with a long history of diabetes and requiring insulin and oral

Results

Baseline clinical characteristics of patients with diabetes and without diabetes are provided in Table 1.

Discussion

The findings of coronary plaque characterization using MSCT angiography, gray-scale, and VH IVUS may be summarized as follows. First, the extent of coronary plaques was higher in diabetic patients on MSCT. This finding corresponded with more diffuse atherosclerosis and a larger plaque burden on gray-scale IVUS examination. Second, the proportion of completely calcified plaques on MSCT was larger in patients with diabetes as compared with patients without diabetes. On VH IVUS, this corresponded

Limitations

The findings of the study are based on a relatively small patient population. Concerning MSCT, the technique is still associated with an elevated x-ray dose, while also the administration of contrast material is required. Also, no validated algorithms that allow quantification of plaque stenosis, volume, and composition are available for MSCT at present. Thus, in the present study MSCT studies were analyzed using a qualitative visual approach without the use of dedicated software algorithms or

Conclusions

In conclusion, differences in coronary plaque patterns were observed on MSCT, gray-scale, and VH IVUS between patients with versus without diabetes. Diabetes was associated with a higher plaque extent as determined both on MSCT and gray-scale IVUS. Concerning plaque composition, more calcified plaques were observed on MSCT in patients with diabetes. On VH IVUS, plaques of diabetic patients contained a larger amount of dense calcium and were of a more advanced stage based on visual

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  • Cited by (0)

    Gabija Pundziute received training fellowship grant from the European Society of Cardiology.

    Jacob M. van Werkhoven received a research grant from the Netherlands Society of Cardiology.

    Gaetano Nucifora received fellowship grant from the European Association of Percutaneous Cardiovascular Interventions.

    Jeroen J. Bax received grants from GE Healthcare, BMS medical imaging, St Jude, Medtronic, Boston Scientific, Biotronik, and Edwards Lifesciences

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