Noninvasive angiography and assessment of left ventricular function using multislice computed tomography in patients with type 2 diabetes.
OBJECTIVE
Early identification of coronary artery disease (CAD) in patients with diabetes is important because these patients are at increased risk for CAD and have worse outcome than nondiabetic patients after CAD is diagnosed. Recently, noninvasive coronary angiography and assessment of left ventricular function has been demonstrated with multislice computed tomography (MSCT). The purpose of the present study was to validate this approach in patients with type 2 diabetes.


METHODS
MSCT was performed in 30 patients with confirmed type 2 diabetes. From the MSCT images, coronary artery stenoses (> or =50% luminal narrowing) and left ventricular function (left ventricular ejection fraction, regional wall motion) were evaluated and compared with results of conventional angiography and two-dimensional echocardiography.


RESULTS
Two hundred twenty of 256 coronary artery segments (86%) were interpretable with MSCT. In these segments, sensitivity and specificity for detection of coronary artery stenoses were 95%. Including the uninterpretable segments, sensitivity and specificity were 81 and 82%, respectively. Bland-Altman analysis in the comparison of left ventricular ejection fractions demonstrated a mean difference of -0.48 +/- 3.8% for MSCT and echocardiography, which was not significantly different from 0. Agreement between the two modalities for assessment of regional contractile function was excellent (91%, kappa statistic 0.81).


CONCLUSIONS
Accurate noninvasive evaluation of both the coronary arteries and left ventricular function with MSCT is feasible in patients with type 2 diabetes. This noninvasive approach may allow optimal identification of high-risk patients.
Schuijf
Joanne D
JD
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
Bax
Jeroen J
JJ
Jukema
J Wouter
JW
Lamb
Hildo J
HJ
Vliegen
Hubert W
HW
Salm
Liesbeth P
LP
de Roos
Albert
A
van der Wall
Ernst E
EE
D003327:Coronary Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036542:Tomography, Spiral Computed / Q000379:methods*; D016277:Ventricular Function, Left / Q000502:physiology*