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Progression of coronary atherosclerotic plaque burden and relationship with adverse cardiovascular event in asymptomatic diabetic patients.
BMC Cardiovasc Disord. 2019 02 11; 19(1):39.BC

Abstract

BACKGROUND

The heterogeneity of risk in patients with diabetes mellitus (DM) is acknowledged in new guidelines promulgating different treatment recommendations for diabetics at low cardiac risk. We performed a retrospective longitudinal follow-up study to evaluate coronary plaque progression and its impact on cardiac events in asymptomatic diabetic patients.

METHODS

Data of 197 asymptomatic patients (63.1 ± 17 years, 60% males) with DM and suspected coronary artery disease (CAD) who underwent clinically indicated dual-source cardiac computed tomography (CT) were retrospectively analyzed. Patients with DM received standard of care treatment. Patients were classified into two groups based on CT coronary artery calcium scores (CACS): A, CACS> 10; B, CACS≤10. Progression of coronary plaque burden in both groups was evaluated and compared by baseline and follow-up coronary CT angiography (CCTA) using semi-automated plaque analysis and quantification software. Follow-up data were retrospectively gathered from medical records and endpoints of cardiac events were recorded via prospective phone-calls. The impacts of plaque composition and progression on cardiac events were specifically assessed.

RESULTS

Patients with CACS> 10 showed an increase in dense coronary calcium volume, while patients with CACS≤10 had a more pronounced increase in the volume of low-attenuation "lipid-rich" plaque components between CCTA acquisitions. The composite endpoint occurred in 20 patients (10.2%) after a median follow-up period of 41.8 months. Furthermore, at follow-up CCTA, the presence of CACS> 10 (adjusted odds ratio, 0.701; 95% CI, 0.612-0.836), increase of dense calcium volume (OR, 0.860 95% CI, 0.771-0.960), and lipid volume (OR, 1.013; 95% CI, 1.007-1.020) were all independent predictors of cardiac events.

CONCLUSION

Asymptomatic patients with DM experienced plaque progression as well as progression to "overt or silent CAD". The relative increase in plaque volume was associated with subsequent cardiac events, and the coronary calcification seemed to be inversely related to the outcome in asymptomatic diabetic patients.

Authors+Show Affiliations

Department of Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China. Master Program of Medical Science and Clinical Investigation, Harvard Medical School, Boston, MA, USA. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.Department of Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. Department of Cardiology and Intensive Care Medicine, Heart Center Munich- Bogenhausen, Munich, Germany.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.Department of Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China. cyundai301@sina.com.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30744612

Citation

Yang, Junjie, et al. "Progression of Coronary Atherosclerotic Plaque Burden and Relationship With Adverse Cardiovascular Event in Asymptomatic Diabetic Patients." BMC Cardiovascular Disorders, vol. 19, no. 1, 2019, p. 39.
Yang J, Dou G, Tesche C, et al. Progression of coronary atherosclerotic plaque burden and relationship with adverse cardiovascular event in asymptomatic diabetic patients. BMC Cardiovasc Disord. 2019;19(1):39.
Yang, J., Dou, G., Tesche, C., De Cecco, C. N., Jacobs, B. E., Schoepf, U. J., & Chen, Y. (2019). Progression of coronary atherosclerotic plaque burden and relationship with adverse cardiovascular event in asymptomatic diabetic patients. BMC Cardiovascular Disorders, 19(1), 39. https://doi.org/10.1186/s12872-019-1016-4
Yang J, et al. Progression of Coronary Atherosclerotic Plaque Burden and Relationship With Adverse Cardiovascular Event in Asymptomatic Diabetic Patients. BMC Cardiovasc Disord. 2019 02 11;19(1):39. PubMed PMID: 30744612.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Progression of coronary atherosclerotic plaque burden and relationship with adverse cardiovascular event in asymptomatic diabetic patients. AU - Yang,Junjie, AU - Dou,Guanhua, AU - Tesche,Christian, AU - De Cecco,Carlo N, AU - Jacobs,Brian E, AU - Schoepf,U Joseph, AU - Chen,Yundai, Y1 - 2019/02/11/ PY - 2018/06/28/received PY - 2019/02/04/accepted PY - 2019/2/13/entrez PY - 2019/2/13/pubmed PY - 2019/12/18/medline KW - Coronary artery disease KW - Coronary computed tomography angiography KW - Outcome KW - Plaque progression KW - Type 2 diabetes SP - 39 EP - 39 JF - BMC cardiovascular disorders JO - BMC Cardiovasc Disord VL - 19 IS - 1 N2 - BACKGROUND: The heterogeneity of risk in patients with diabetes mellitus (DM) is acknowledged in new guidelines promulgating different treatment recommendations for diabetics at low cardiac risk. We performed a retrospective longitudinal follow-up study to evaluate coronary plaque progression and its impact on cardiac events in asymptomatic diabetic patients. METHODS: Data of 197 asymptomatic patients (63.1 ± 17 years, 60% males) with DM and suspected coronary artery disease (CAD) who underwent clinically indicated dual-source cardiac computed tomography (CT) were retrospectively analyzed. Patients with DM received standard of care treatment. Patients were classified into two groups based on CT coronary artery calcium scores (CACS): A, CACS> 10; B, CACS≤10. Progression of coronary plaque burden in both groups was evaluated and compared by baseline and follow-up coronary CT angiography (CCTA) using semi-automated plaque analysis and quantification software. Follow-up data were retrospectively gathered from medical records and endpoints of cardiac events were recorded via prospective phone-calls. The impacts of plaque composition and progression on cardiac events were specifically assessed. RESULTS: Patients with CACS> 10 showed an increase in dense coronary calcium volume, while patients with CACS≤10 had a more pronounced increase in the volume of low-attenuation "lipid-rich" plaque components between CCTA acquisitions. The composite endpoint occurred in 20 patients (10.2%) after a median follow-up period of 41.8 months. Furthermore, at follow-up CCTA, the presence of CACS> 10 (adjusted odds ratio, 0.701; 95% CI, 0.612-0.836), increase of dense calcium volume (OR, 0.860 95% CI, 0.771-0.960), and lipid volume (OR, 1.013; 95% CI, 1.007-1.020) were all independent predictors of cardiac events. CONCLUSION: Asymptomatic patients with DM experienced plaque progression as well as progression to "overt or silent CAD". The relative increase in plaque volume was associated with subsequent cardiac events, and the coronary calcification seemed to be inversely related to the outcome in asymptomatic diabetic patients. SN - 1471-2261 UR - https://www.unboundmedicine.com/medline/citation/30744612/Progression_of_coronary_atherosclerotic_plaque_burden_and_relationship_with_adverse_cardiovascular_event_in_asymptomatic_diabetic_patients_ L2 - https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-019-1016-4 DB - PRIME DP - Unbound Medicine ER -