Noninvasive assessment of the prevalence and characteristics of coronary atherosclerotic plaques by multidetector computed tomography in asymptomatic type 2 diabetic patients at high risk of significant coronary artery disease: a preliminary study.
BACKGROUND
There is a need to identify diabetic patients at risk of cardiovascular events before symptom onset.


OBJECTIVE
To evaluate the prevalence and characteristics of coronary atherosclerotic plaques in asymptomatic type 2 diabetic patients with coronary risk factors but without known coronary artery disease, using multidetector computed tomography.


METHODS
High-resolution 40-slice coronary computed tomography was performed prospectively in 42 consecutive type 2 diabetic patients (mean age 62 years; range 50-77 years; 28 men) with over one or more carotid atherosclerotic plaque and no coronary artery disease symptoms. Computed tomography data were evaluated for calcium score and the presence of coronary plaques. Plaque type, distribution, extensive character and obstructive nature were determined per patient for each segment.


RESULTS
No plaques were detected in 11 (26.2%) patients. Atherosclerotic plaques were detected in 31 (73.8%) patients. A total of 147 coronary segments with plaque were identified, of which 11 (7.5%) contained hypodense plaques, 28 (19%) mixed plaques and 108 (73.5%) calcified plaques. Hypodense plaques were noted in 4/15 (26.7%) patients without coronary calcifications. Most calcified and hypodense plaques resulted in lumen narrowing of less than 50%; most mixed plaques resulted in lumen narrowing greater than 50%. Obstructive disease was detected in 9/11 patients with a high calcium score (>400).


CONCLUSIONS
This preliminary study demonstrates that a high proportion of asymptomatic type 2 diabetic patients present without coronary plaques detectable by multidetector computed tomography, despite concomitant carotid atherosclerotic lesions. Computed tomography seems to detect a high proportion of plaques compared with conventional angiography in these specific patients.
Department of Cardiovascular Imaging, Louis-Pradel Hospital, LRMN Creatis, UMR CNRS 5515, Inserm U630, Claude-Bernard University, Lyon 1, 28 Avenue du Doyen-Jean-Lépine, 69500 Lyon, France. romaric.loffroy@chu-dijon.fr
Romaric
R
Loffroy
Sophie
S
Bernard
André
A
Sérusclat
Loïc
L
Boussel
Eric
E
Bonnefoy
Philippe
P
D'Athis
Philippe
P
Moulin
Didier
D
Revel
Philippe
P
Douek
D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D018570:Risk Assessment; D012720:Severity of Illness Index; D036542:Tomography, Spiral Computed