Original ArticleType 2 diabetes is associated with more advanced coronary atherosclerosis on multislice computed tomography and virtual histology intravascular ultrasound
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
See related editorial, doi: 10.1007/s12350-009-9069-x