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Published on: October 28, 2020
Determining Early Remodeling Patterns in Diabetes and Hypertension Using Cardiac Computed Tomography: The Feasibility
Jeroen Walpot1, Joao R Inácio2, Samia Massalha1
1University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada.
Insights
Cardiac computed tomography angiography (CCTA) can detect early left ventricle (LV) geometric changes in patients with diabetes mellitus (DM) and hypertension (HTN) before structural heart disease develops.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Conflicting data exists regarding early left ventricle (LV) remodeling in diabetes mellitus (DM) and hypertension (HTN).
- Early detection of LV geometric changes is crucial for managing cardiovascular risk in these patient populations.
Purpose of the Study:
- To assess the feasibility of cardiac computed tomography angiography (CCTA) in identifying early LV geometric alterations.
- To investigate CCTA's ability to differentiate between patients with and without DM and HTN based on LV structure.
Main Methods:
- Prospective electrocardiography (ECG)-triggered CCTA was performed on 5,992 patients.
- Exclusion criteria included known structural heart disease or LV dysfunction.
- Left ventricular mass (LVM) and LV mid-diastolic volume (LVMDV) were measured, and LV concentricity (LVM/LVMDV) was calculated and indexed to body surface area (BSA) in 4,283 patients.
Main Results:
- Patients with HTN and HTN + DM showed increased LVM indexed to BSA (LVMi) compared to normal subjects (P < 0.05).
- DM alone did not significantly alter LVMi compared to normal subjects (P = 0.617).
- Concentricity indices were significantly higher in patients with HTN, DM, and HTN + DM compared to normal individuals (P < 0.001).
Conclusions:
- CCTA-derived measures of LVM and LV concentricity index show potential for discriminating patients with HTN and DM.
- These CCTA parameters may identify early LV remodeling before overt structural heart disease is apparent.
Background:
There is conflicting data on early left ventricle (LV) remodeling in diabetes mellitus (DM) and hypertension (HTN). This study examines the feasibility of cardiac computed tomography angiography (CCTA) to detect early LV geometric changes in patients with DM and HTN.
Methods:
Consecutive patients (n = 5,992) who underwent prospective electrocardiography (ECG)-triggered (mid-diastolic) CCTA were screened. Patients with known structural heart disease or known LV dysfunction were excluded. Left ventricular mass (LVM), left ventricular mid-diastolic volume (LVMDV), and LV concentricity (LVM/LVMDV) were measured and indexed to body surface area.
Results:
A total of 4,283 patients were analyzed (mean age 57 ± 10.69 years, female 46.7%). DM, HTN, and HTN + DM were present in 4.1%, 35.8% and 10.6% of patients, respectively. Compared to normal patients, HTN and HTN + DM patients had increased LVM indexed to body surface area (LVMi) (56.87 ± 17.24, 59.26 ± 13.62, and 58.56 ± 13.09, respectively; P < 0.05). There was no difference in LVMi between normal subjects and patients with DM (56.39 ± 11.50, P = 0.617).Concentricity indices were higher in patient with HTN (1.0456 ± 0.417; P < 0.001), DM (1.109 ± 0.638; P = 0.004), and HTN + DM (1.083 ± 0.311, P < 0.001) than normal individuals (0.9671 ± 0.361). There was no overlap of the 95% confidence intervals in the composite of concentricity indices and LVMi between the different groups.
Conclusions:
CCTA measures of LVM and concentricity index may discriminate patients with HTN and DM before overt structural heart disease.
