Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy.
Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Via Conca 71, 60126, Ancona, Italy.
Radiol Med. 2020 Dec;125(12):1249-1259. doi: 10.1007/s11547-020-01204-z. Epub 2020 May 4.
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).
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.
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).
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.
作为心血管疾病最常见的危险因素之一，2 型糖尿病（T2DM）是最大的死亡原因之一。然而，糖尿病患者的急性心脏表现并不少见，目前的检查方法往往仍不够充分。我们的研究目的是使用低剂量 640 层冠状动脉计算机断层扫描血管造影（CCTA）回顾性分层无症状 T2DM 患者的风险。
分析了 62 例（平均年龄 65 岁）既往诊断为 2 型糖尿病且无心脏症状的患者的 CCTA 检查结果。使用 640 层 CT 进行图像采集。对每位患者、每条血管和每个斑块进行分析。根据 ESC 指南评估分层风险。患者在 CCTA 检查后 2.21±0.56 年进行随访。
58 例（93.55%）患者发现冠状动脉疾病（CAD），共 290 个斑块。对所有样本的分析显示，24 例（38.7%的病例）存在严重至闭塞性动脉粥样硬化。然而，根据 CAD 程度的扩展，23 例患者被评估为高风险。根据 Kaplan-Meier 生存分析（p 值=0.001），CAD 扩展/风险评估和 MACE 发生率之间显示出良好的相关性，显示出 7.25 倍的风险增加（HR 7.25 CI 2.13-24.7；p 值=0.002）。
我们的研究证实了 CCTA 能够正确分层无症状 T2DM 患者的心血管风险。如果考虑到目前用于正确评估这些患者的检查策略似乎常常不够充分，那么可以推荐使用 CCTA。
