Assessment of Subclinical Coronary Atherosclerosis in Asymptomatic Patients With Type 2 Diabetes Mellitus With Single Photon Emission Computed Tomography and Coronary Computed Tomography Angiography

• Published in: The American journal of cardiology Vol. 104; no. 7; pp. 890 - 896
• Main Authors: Choi, Eue-Keun, MD, Chun, Eun Ju, MD, Choi, Sang-Il, MD, Chang, Sung-A., MD, Choi, Sung-Hee, MD, Lim, Soo, MD, Rivera, Juan J., MD, Nasir, Khurram, MD, Blumenthal, Roger S., MD, Jang, Hak-Chul, MD, Chang, Hyuk-Jae, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2009; Elsevier; Elsevier Limited
• Subjects: Age Distribution; Aged; Arteriosclerosis; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Cohort Studies; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary heart disease; Diabetes; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; Heart; Humans; Incidence; Investigative techniques, diagnostic techniques (general aspects); Male; Medical imaging; Medical sciences; Middle Aged; Probability; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Reference Values; Risk Assessment; Risk factors; Sensitivity and Specificity; Severity of Illness Index; Sex Distribution; Survival Rate; Tomography; Tomography, Emission-Computed, Single-Photon - methods; Tomography, X-Ray Computed - methods; Endocrinopathy; Radionuclide study; Type 2 diabetes; Human; Radiodiagnosis; Metabolic diseases; Cardiovascular disease; Patient; Asymptomatic; Coronary arteriography; Single photon emission tomography; Coronary heart disease; Vascular disease; Atherosclerosis; Medical imagery; Computerized axial tomography; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.05.026

We evaluated the characteristics of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus (DM) using single photon emission computed tomography (SPECT) and coronary computed tomographic angiography (CCTA). A total of 116 patients with DM without abnormal electrocardiographic findings or evidence of peripheral arterial disease (number of risk factors ≥2; 62 ± 7 years, 59% men) underwent CCTA and SPECT. Of the 116 patients with DM, 88 (76%) had a normal single photon emission computed tomographic findings, and 28 (24%) had abnormal perfusion defects. Of the 116 patients, 92 (79%) had atherosclerotic plaques (2 ± 2 segments per subject), and 20 (17%) had significant stenosis seen on CCTA. Patients with DM and normal findings on SPECT had a similar prevalence of atherosclerotic plaque (78% vs 82%), significant stenosis (15% vs 25%), severe stenosis (7% vs 7%), and calcified (40% vs 43%), mixed (49% vs 57%), and noncalcified plaques (26% vs 29%) and a high (>100) coronary artery calcium score (32% vs 29%; all p >0.05) compared to those with abnormal findings on SPECT. During the mid-term follow-up (24 ± 4 months), 5 cardiac events occurred in patients with DM and normal findings on SPECT, only in those with occult CAD on CCTA: 1 sudden cardiac death and 4 revascularization procedures. In conclusion, a significant percentage of patients with DM and normal eletrocardiographic findings, no peripheral arterial disease, and normal findings on SPECT have evidence of occult CAD on CCTA. Furthermore, a small percentage had had a cardiac event by mid-term follow-up. SPECT showed limited capability to differentiate the coronary risks between patients with DM and no coronary plaque and from those with a certain degree of disease; 2 circumstances that represent different coronary risks.