title: Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics?: results of a long term follow-up.
abstract: BACKGROUND
  Doubts remain about atherosclerotic disease and risk stratification of asymptomatic type-2 diabetic patients (T2DP). This study aims to evaluate the usefulness of calcium score (CS) and coronary computed tomography (CT) angiography (CTA) to predict fatal and non fatal cardiovascular events (CVEV) in T2DP.
  
  
  METHODS
  Eighty-five consecutive T2DP undergoing CT (Phillips Brilliance, 16-slice) with CS and CTA were prospectively enrolled in a transversal case-control study. Patients were followed for 48 months (range 18 - 68) to assess CVEV: cardiovascular death, acute coronary syndrome, revascularisation and stroke. Potential predictors of CVEV were identified. Predictive models based on clinical features, CTA and CS were created and compared.
  
  
  RESULTS
  Performing CT impacted T2DP treatment. Cardiovascular risk was lowered during follow-up but metabolic control remained suboptimal. CVEV occurred in 11.8% T2DP (3.1%/year). CS ≥86.6 was predictor of CVEV over time, with a high negative predictive value, an 80% sensitivity and 74.7% specificity. Although its prognostic value was not independent of the presence/absence of obstructive CAD, adding CS and CTA data to clinical parameters improved the prediction of CVEV: the combined model had the highest AUC (0.888, 95%CI 0.789-0.987, p < 0.001) for the prediction of the study endpoints.
  
  
  CONCLUSIONS
  CS showed great value in T2DP risk stratification and its prognostic value was further enhanced by CTA data. Information provided by CT may help predict CVEV in T2DP and potentially improve their outcome.
authors.affiliation: Cardiology Department, Coimbra's Hospital and University Centre - General Hospital, Coimbra, Portugal. anacatarina.faustino@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Faustino
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.forename: Paula
authors.initials: P
authors.lastname: Mota
authors.forename: Sérgio
authors.initials: S
authors.lastname: Barra
authors.forename: Joana
authors.initials: J
authors.lastname: Silva
authors.forename: Andreia
authors.initials: A
authors.lastname: Fernandes
authors.forename: Rui
authors.initials: R
authors.lastname: Catarino
authors.forename: Susana
authors.initials: S
authors.lastname: Basso
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
authors.forename: António
authors.initials: A
authors.lastname: Leitão-Marques
mesh_terms: D000368:Aged; D019540:Area Under Curve; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control