Diagnostic accuracy of multislice computed tomography for the detection of coronary artery disease in diabetic patients.
BACKGROUND
Diabetes mellitus is an important risk factor for coronary artery disease. Cardiac multislice computed tomography (MSCT) permits visualization of the coronary arteries with good sensitivity and specificity. However, at present, there are no data whether MSCT allows an accurate assessment of coronary arteries of diabetic patients, in comparison to nondiabetic patients. Thus, we compared the catheter-controlled MSCT results from diabetic and nondiabetic patients in a cohort of 116 patients with regard to sensitivity, specificity, positive predictive value, and negative predictive value, as well as image quality.


METHODS
Twenty-two diabetic patients (age, 64.6+/-8.5 years; number of risk factors, 3.4+/-1.1) and 94 nondiabetic patients (age, 64.2+/-9.2 years; number of risk factors, 2.4+/-1.0) were examined by MSCT (Sensation 16 Speed 4 D, Siemens, Forchheim, Germany; gantry rotation time, 375 ms) and invasive coronary angiography. MSCT results were compared, blinded to the results of the coronary angiography with regard to the presence or absence of a significant stenosis (>50%) in a modified American Heart Association 13-segment model. Image quality was assessed on a qualitative scale between 1 (very good) and 5 (invisible) for each segment.


RESULTS
Sensitivity, specificity, positive predictive value, and negative predictive value were statistically not different in diabetic and nondiabetic patients (0.85/0.98/0.92/0.96 vs. 0.84/0.97/0.91/0.95). One diabetic and three nondiabetic patients had to be excluded from analysis. Diabetic patients had relevantly more risk factors (P < .05), but calcium scoring was not different in both groups (Agatston score 1090+/-1278 vs. 798+/-1033). The image quality in both cohorts was comparable.


CONCLUSIONS
MSCT allows the assessment of the coronary arteries noninvasively in diabetic patients with a good sensitivity and specificity, and diabetes does not have an impact on the number of evaluable segments. Thus, MSCT is a noninvasive tool in the care of these patients.
Burgstahler
Christof
C
Division of Cardiology, Department of Internal Medicine, Eberhard-Karls-University Tuebingen, 72076 Tuebingen, Germany.
Beck
Torsten
T
Reimann
Anja
A
Kuettner
Axel
A
Kopp
Andreas F
AF
Heuschmid
Martin
M
Claussen
Claus D
CD
Schroeder
Stephen
S
D000368:Aged; D002114:Calcinosis / Q000175:diagnosis; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000175:diagnosis; D003925:Diabetic Angiopathies / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000295:instrumentation / Q000379:methods*