Ischemia imaging and plaque imaging in diabetes: complementary tools to improve cardiovascular risk management.
Cardiovascular disease is the most frequent cause of death and disability in diabetes, and the morbidity and mortality for coronary artery disease (CAD) in this population is two to four times higher than in nondiabetic subjects. Traditional risk factors do not fully explain the level of cardiovascular risk, and coronary disease events are often silent in diabetic patients. Thus, research has recently focused on improving the risk assessment of an individual patient with new tools in an effort to better identify subjects at highest risk and in need of aggressive management. Cardiovascular imaging has proven very helpful in this regard. Traditional methods to assess CAD are based on detection of obstructive luminal disease responsible for myocardial ischemia. However, acute coronary syndromes often occur in the absence of luminal stenoses. Hence, the utilization of imaging methodologies to visualize atherosclerosis in its presymptomatic stages has received mounting attention in recent years. In this article, we review the current literature on the utility of traditional imaging modalities for obstructive CAD (nuclear and echocardiographic stress testing) as well as atherosclerosis plaque imaging with carotid intima-media thickness and coronary artery calcium for risk stratification of diabetic patients.
Raggi
Paolo
P
Section of Cardiology, Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA. praggi@tulane.edu
Bellasi
Antonio
A
Ratti
Carlo
C
D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D048909:Diabetes Complications; D003920:Diabetes Mellitus; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D025401:Echocardiography, Stress; D006801:Humans; D018810:Magnetic Resonance Angiography; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011859:Radiography; D012308:Risk Management; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D013794:Thallium Radioisotopes; C078700:technetium tc-99m tetrofosmin; D017256:Technetium Tc 99m Sestamibi