采用连续冠状动脉计算机断层扫描血管造影术评估与血糖状态相关的冠状动脉斑块体积变化的纵向评估：PARADIGM（通过计算机断层扫描血管造影成像确定动脉粥样硬化斑块的进展）子研究。

Longitudinal assessment of coronary plaque volume change related to glycemic status using serial coronary computed tomography angiography: A PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging) substudy.

机构信息

Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea; Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.

Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.

出版信息

J Cardiovasc Comput Tomogr. 2019 Mar-Apr;13(2):142-147. doi: 10.1016/j.jcct.2018.12.002. Epub 2018 Dec 17.

DOI:10.1016/j.jcct.2018.12.002

PMID:30580992

Abstract

BACKGROUND

Data on the impact of glycemic status on coronary plaque progression have been limited. This study evaluated the association between glycemic status and coronary plaque volume change (PVC) using coronary computed tomography angiography (CCTA).

METHODS

A total of 1296 subjects (61 ± 9, 56.9% male) who underwent serial CCTA with available glycemic status were enrolled and analyzed from the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. The median inter-scan period was 3.2 (2.6-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were categorized into the following groups according to glycemic status: normal, pre-diabetes (pre-DM), and diabetes mellitus (DM).

RESULTS

During the follow-up, significant differences in PVC (normal: 51.3 ± 83.3 mm vs. pre-DM: 51.0 ± 84.3 mm vs. DM: 72.6 ± 95.0 mm; p < 0.001) and annualized PVC (normal: 14.9 ± 24.9 mm vs. pre-DM: 15.7 ± 23.8 mm vs. DM: 21.0 ± 27.7 mm; p = 0.001) were observed among the 3 groups. Compared with normal individuals, individuals with pre-DM showed no significant differences in the adjusted odds ratio (OR) for plaque progression (PP) (1.338, 95% confidence interval [CI] 0.967-1.853; p = 0.079). However, the adjusted OR for PP was higher in DM individuals than in normal individuals (1.635, 95% CI 1.126-2.375; p = 0.010).

CONCLUSION

DM had an incremental impact on coronary PP, but pre-DM appeared to have no significant association with an increased risk of coronary PP after adjusting for confounding factors.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.govNCT02803411.

摘要

背景

关于血糖状态对冠状动脉斑块进展影响的数据有限。本研究通过冠状动脉计算机断层扫描血管造影术（CCTA）评估了血糖状态与冠状动脉斑块体积变化（PVC）之间的关联。

方法

共纳入 1296 例（61±9，56.9%为男性）连续接受 CCTA 检查且血糖状态可获得的患者，并对其进行分析。这些患者来自于粥样硬化斑块进展的前瞻性评估-计算机断层扫描血管造影成像研究（PARADIGM）注册研究。两次扫描的中位间隔时间为 3.2（2.6-4.4）年。两次扫描均对冠状动脉斑块进行定量评估。根据血糖状态，所有患者分为以下三组：正常、糖尿病前期（pre-DM）和糖尿病（DM）。

结果

在随访期间，三组间的 PVC（正常：51.3±83.3mm vs. pre-DM：51.0±84.3mm vs. DM：72.6±95.0mm；p<0.001）和年化 PVC（正常：14.9±24.9mm vs. pre-DM：15.7±23.8mm vs. DM：21.0±27.7mm；p=0.001）均有显著差异。与正常个体相比，糖尿病前期患者的斑块进展（PP）调整后比值比（OR）无显著差异（1.338，95%置信区间[CI]：0.967-1.853；p=0.079）。然而，DM 患者的 PP 调整后 OR 高于正常患者（1.635，95%CI：1.126-2.375；p=0.010）。