Assessment of Subclinical Coronary Atherosclerosis in Asymptomatic Patients With Type 2 Diabetes Mellitus With Single Photon Emission Computed Tomography and Coronary Computed Tomography Angiography

Eue Keun Choi, Eun Ju Chun, Sang Il Choi, Sung A. Chang, Sung Hee Choi, Soo Lim, Juan J. Rivera, Khurram Nasir, Roger S Blumenthal, Hak Chul Jang, Hyuk Jae Chang

Research output: Contribution to journalArticle

Abstract

We evaluated the characteristics of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus (DM) using single photon emission computed tomography (SPECT) and coronary computed tomographic angiography (CCTA). A total of 116 patients with DM without abnormal electrocardiographic findings or evidence of peripheral arterial disease (number of risk factors ≥2; 62 ± 7 years, 59% men) underwent CCTA and SPECT. Of the 116 patients with DM, 88 (76%) had a normal single photon emission computed tomographic findings, and 28 (24%) had abnormal perfusion defects. Of the 116 patients, 92 (79%) had atherosclerotic plaques (2 ± 2 segments per subject), and 20 (17%) had significant stenosis seen on CCTA. Patients with DM and normal findings on SPECT had a similar prevalence of atherosclerotic plaque (78% vs 82%), significant stenosis (15% vs 25%), severe stenosis (7% vs 7%), and calcified (40% vs 43%), mixed (49% vs 57%), and noncalcified plaques (26% vs 29%) and a high (>100) coronary artery calcium score (32% vs 29%; all p >0.05) compared to those with abnormal findings on SPECT. During the mid-term follow-up (24 ± 4 months), 5 cardiac events occurred in patients with DM and normal findings on SPECT, only in those with occult CAD on CCTA: 1 sudden cardiac death and 4 revascularization procedures. In conclusion, a significant percentage of patients with DM and normal eletrocardiographic findings, no peripheral arterial disease, and normal findings on SPECT have evidence of occult CAD on CCTA. Furthermore, a small percentage had had a cardiac event by mid-term follow-up. SPECT showed limited capability to differentiate the coronary risks between patients with DM and no coronary plaque and from those with a certain degree of disease; 2 circumstances that represent different coronary risks.

Original languageEnglish (US)
Pages (from-to)890-896
Number of pages7
JournalThe American Journal of Cardiology
Volume104
Issue number7
DOIs
StatePublished - Oct 1 2009

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Type 2 Diabetes Mellitus
Single-Photon Emission-Computed Tomography
Coronary Artery Disease
Diabetes Mellitus
Angiography
Pathologic Constriction
Peripheral Arterial Disease
Atherosclerotic Plaques
Single Photon Emission Computed Tomography Computed Tomography
Computed Tomography Angiography
Sudden Cardiac Death
Photons
Coronary Vessels
Perfusion
Calcium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Assessment of Subclinical Coronary Atherosclerosis in Asymptomatic Patients With Type 2 Diabetes Mellitus With Single Photon Emission Computed Tomography and Coronary Computed Tomography Angiography. / Choi, Eue Keun; Chun, Eun Ju; Choi, Sang Il; Chang, Sung A.; Choi, Sung Hee; Lim, Soo; Rivera, Juan J.; Nasir, Khurram; Blumenthal, Roger S; Jang, Hak Chul; Chang, Hyuk Jae.

In: The American Journal of Cardiology, Vol. 104, No. 7, 01.10.2009, p. 890-896.

Research output: Contribution to journalArticle

Choi, Eue Keun ; Chun, Eun Ju ; Choi, Sang Il ; Chang, Sung A. ; Choi, Sung Hee ; Lim, Soo ; Rivera, Juan J. ; Nasir, Khurram ; Blumenthal, Roger S ; Jang, Hak Chul ; Chang, Hyuk Jae. / Assessment of Subclinical Coronary Atherosclerosis in Asymptomatic Patients With Type 2 Diabetes Mellitus With Single Photon Emission Computed Tomography and Coronary Computed Tomography Angiography. In: The American Journal of Cardiology. 2009 ; Vol. 104, No. 7. pp. 890-896.
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abstract = "We evaluated the characteristics of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus (DM) using single photon emission computed tomography (SPECT) and coronary computed tomographic angiography (CCTA). A total of 116 patients with DM without abnormal electrocardiographic findings or evidence of peripheral arterial disease (number of risk factors ≥2; 62 ± 7 years, 59{\%} men) underwent CCTA and SPECT. Of the 116 patients with DM, 88 (76{\%}) had a normal single photon emission computed tomographic findings, and 28 (24{\%}) had abnormal perfusion defects. Of the 116 patients, 92 (79{\%}) had atherosclerotic plaques (2 ± 2 segments per subject), and 20 (17{\%}) had significant stenosis seen on CCTA. Patients with DM and normal findings on SPECT had a similar prevalence of atherosclerotic plaque (78{\%} vs 82{\%}), significant stenosis (15{\%} vs 25{\%}), severe stenosis (7{\%} vs 7{\%}), and calcified (40{\%} vs 43{\%}), mixed (49{\%} vs 57{\%}), and noncalcified plaques (26{\%} vs 29{\%}) and a high (>100) coronary artery calcium score (32{\%} vs 29{\%}; all p >0.05) compared to those with abnormal findings on SPECT. During the mid-term follow-up (24 ± 4 months), 5 cardiac events occurred in patients with DM and normal findings on SPECT, only in those with occult CAD on CCTA: 1 sudden cardiac death and 4 revascularization procedures. In conclusion, a significant percentage of patients with DM and normal eletrocardiographic findings, no peripheral arterial disease, and normal findings on SPECT have evidence of occult CAD on CCTA. Furthermore, a small percentage had had a cardiac event by mid-term follow-up. SPECT showed limited capability to differentiate the coronary risks between patients with DM and no coronary plaque and from those with a certain degree of disease; 2 circumstances that represent different coronary risks.",
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AU - Chun, Eun Ju

AU - Choi, Sang Il

AU - Chang, Sung A.

AU - Choi, Sung Hee

AU - Lim, Soo

AU - Rivera, Juan J.

AU - Nasir, Khurram

AU - Blumenthal, Roger S

AU - Jang, Hak Chul

AU - Chang, Hyuk Jae

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N2 - We evaluated the characteristics of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus (DM) using single photon emission computed tomography (SPECT) and coronary computed tomographic angiography (CCTA). A total of 116 patients with DM without abnormal electrocardiographic findings or evidence of peripheral arterial disease (number of risk factors ≥2; 62 ± 7 years, 59% men) underwent CCTA and SPECT. Of the 116 patients with DM, 88 (76%) had a normal single photon emission computed tomographic findings, and 28 (24%) had abnormal perfusion defects. Of the 116 patients, 92 (79%) had atherosclerotic plaques (2 ± 2 segments per subject), and 20 (17%) had significant stenosis seen on CCTA. Patients with DM and normal findings on SPECT had a similar prevalence of atherosclerotic plaque (78% vs 82%), significant stenosis (15% vs 25%), severe stenosis (7% vs 7%), and calcified (40% vs 43%), mixed (49% vs 57%), and noncalcified plaques (26% vs 29%) and a high (>100) coronary artery calcium score (32% vs 29%; all p >0.05) compared to those with abnormal findings on SPECT. During the mid-term follow-up (24 ± 4 months), 5 cardiac events occurred in patients with DM and normal findings on SPECT, only in those with occult CAD on CCTA: 1 sudden cardiac death and 4 revascularization procedures. In conclusion, a significant percentage of patients with DM and normal eletrocardiographic findings, no peripheral arterial disease, and normal findings on SPECT have evidence of occult CAD on CCTA. Furthermore, a small percentage had had a cardiac event by mid-term follow-up. SPECT showed limited capability to differentiate the coronary risks between patients with DM and no coronary plaque and from those with a certain degree of disease; 2 circumstances that represent different coronary risks.

AB - We evaluated the characteristics of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus (DM) using single photon emission computed tomography (SPECT) and coronary computed tomographic angiography (CCTA). A total of 116 patients with DM without abnormal electrocardiographic findings or evidence of peripheral arterial disease (number of risk factors ≥2; 62 ± 7 years, 59% men) underwent CCTA and SPECT. Of the 116 patients with DM, 88 (76%) had a normal single photon emission computed tomographic findings, and 28 (24%) had abnormal perfusion defects. Of the 116 patients, 92 (79%) had atherosclerotic plaques (2 ± 2 segments per subject), and 20 (17%) had significant stenosis seen on CCTA. Patients with DM and normal findings on SPECT had a similar prevalence of atherosclerotic plaque (78% vs 82%), significant stenosis (15% vs 25%), severe stenosis (7% vs 7%), and calcified (40% vs 43%), mixed (49% vs 57%), and noncalcified plaques (26% vs 29%) and a high (>100) coronary artery calcium score (32% vs 29%; all p >0.05) compared to those with abnormal findings on SPECT. During the mid-term follow-up (24 ± 4 months), 5 cardiac events occurred in patients with DM and normal findings on SPECT, only in those with occult CAD on CCTA: 1 sudden cardiac death and 4 revascularization procedures. In conclusion, a significant percentage of patients with DM and normal eletrocardiographic findings, no peripheral arterial disease, and normal findings on SPECT have evidence of occult CAD on CCTA. Furthermore, a small percentage had had a cardiac event by mid-term follow-up. SPECT showed limited capability to differentiate the coronary risks between patients with DM and no coronary plaque and from those with a certain degree of disease; 2 circumstances that represent different coronary risks.

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