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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery disease is detectable by multi-slice computed tomography in most asymptomatic type 2 diabetic
Rodolfo Nasti1, Ornella Carbonara, Maria L Mangoni di Santo Stefano
1Department of Experimental and Internal Medicine Lanzara-Magrassi, Center of Cardiovascular Excellence, Second University of Naples, Via F. Petrarca, 64, I-80122, Naples, Italy.
Insights
Multi-slice computed tomography (MSCT) angiography better identifies coronary artery disease (CAD) in asymptomatic type 2 diabetes patients with diabetic nephropathy than myocardial SPECT. This advanced imaging detects significant blockages, guiding revascularization.
Area of Science:
- Cardiology
- Radiology
- Diabetology
Background:
- Non-invasive testing frequently fails to detect coronary artery disease (CAD) in diabetic individuals.
- Asymptomatic type 2 diabetes patients with diabetic nephropathy represent a high-risk group for cardiovascular events.
Purpose of the Study:
- To investigate the prevalence of CAD in asymptomatic, high-risk type 2 diabetes patients with negative nuclear imaging.
- To evaluate the efficacy of multi-slice computed tomography (MSCT) angiography in identifying CAD in this population.
Main Methods:
- A cross-sectional study screened 770 type 2 diabetes patients, enrolling 132 eligible Caucasians with diabetic nephropathy.
- Myocardial Single Photon Emission Tom Tomography (SPECT) excluded ischemia; MSCT angiography was then performed.
- Conventional coronary angiography (CCA) was used to confirm obstructive plaques (≥ 50% lumen narrowing) identified by MSCT.
Main Results:
- MSCT angiography identified CAD in 90% (114/132) of patients.
- Obstructive plaques were found in 48% (60/114) of those with positive MSCT.
- CCA confirmed significant stenosis (≥ 50%) in 80% (48/60) of patients with obstructive plaques, with 35% (21/60) requiring revascularization.
Conclusions:
- MSCT angiography appears superior to myocardial SPECT for detecting CAD in asymptomatic type 2 diabetes patients with diabetic nephropathy.
- The findings highlight the utility of MSCT in identifying significant coronary artery disease in this high-risk cohort.
Objective:
Non-invasive testing often does not identify coronary artery disease (CAD) in diabetic subjects. This study was designed in order to examine the prevalence of CAD in a cohort of asymptomatic type 2 diabetic patients at high cardiovascular risk and negative nuclear imaging, using multi-slice computed tomography (MSCT) angiography.
Methods:
In total, 770 type 2 diabetic patients were screened from January 2008 through July 2010. Of these, 132 Caucasians with diabetic nephropathy and asymptomatic for angina were eligible for a cross-sectional study. Patients underwent MSCT after ischaemia was excluded by myocardial Single Photon Emission Computed Tomography (SPECT) at rest and after dynamic exercise. When obstructive plaques were found (≥ 50% lumen narrowing), patients were sent to conventional coronary angiography (CCA).
Results:
Six subjects were not included in the analysis because of motion artefacts. MSCT was positive for CAD in 114 patients (90%). Within patients with positive MSCT, 60 (48% of all) showed one or more obstructive plaques. CCA confirmed significant stenosis (≥ 50%) in 48 of these 60 patients (80%). Some 21 (35%) showed stenosis ≥ 75% and were submitted to the revascularisation procedure.
Conclusion:
MSCT seems to better identify CAD than myocardial SPECT in asymptomatic patients with type 2 diabetes and diabetic nephropathy.
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