Comprehensive evaluation of coronary arteries by multidetector-row cardiac computed tomography according to the glucose level of asymptomatic individuals

Lim, Soo; Choi, Sung Hee; Choi, Eue-Keun; Chang, Sung-A; Ku, Yun Hyi; Chun, Eun Ju; Choi, Sang Il; Jang, Hak Chul; Chang, Hyuk-Jae

doi:10.1016/j.atherosclerosis.2008.10.041

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Volume 205, Issue 1 , Pages 156-162, July 2009

Comprehensive evaluation of coronary arteries by multidetector-row cardiac computed tomography according to the glucose level of asymptomatic individuals

Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Seongnam-city, Gyeonggi-do 463-707, South Korea
- Seoul National University College of Medicine, South Korea
- These authors equally contributed to this study.
Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Seongnam-city, Gyeonggi-do 463-707, South Korea
- Seoul National University College of Medicine, South Korea
- These authors equally contributed to this study.
Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Seongnam-city, Gyeonggi-do 463-707, South Korea
Sung-A Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Seongnam-city, Gyeonggi-do 463-707, South Korea
Yun Hyi Ku
- Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Seongnam-city, Gyeonggi-do 463-707, South Korea
Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, South Korea
Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, South Korea
- Seoul National University College of Medicine, South Korea
Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Seongnam-city, Gyeonggi-do 463-707, South Korea
- Seoul National University College of Medicine, South Korea
- Corresponding authors at: Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Seongnam-city, Gyeonggi-do 463-707, South Korea. Tel.: +82 31 787 7024; fax: +82 31 787 4052.
Hyuk-Jae Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Seongnam-city, Gyeonggi-do 463-707, South Korea
- Seoul National University College of Medicine, South Korea
- Corresponding authors at: Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Seongnam-city, Gyeonggi-do 463-707, South Korea. Tel.: +82 31 787 7024; fax: +82 31 787 4052.

Received 18 May 2008; received in revised form 14 October 2008; accepted 31 October 2008. published online 17 December 2008.

Abstract

Background

Early detection of atherosclerosis in individuals with diabetes is important because of high cardiovascular mortality in this population. We performed multidetector-row computed tomography (MDCT) in asymptomatic individuals to investigate the status of coronary artery stenosis and plaque characteristics depending on the glucose level.

Methods and results

The plaque burden (number of diseased coronary segments), severity of stenosis, plaques characteristics, and coronary artery calcium score (CACS) were assessed by MDCT in 1043 asymptomatic individuals. Anthropometric parameters and metabolic profiles were also acquired. Twenty-one percents of subjects had plaques and 5% had significant stenosis. Mean (±S.D.) CACS of study population was 17±81. Subjects with impaired fasting glucose (IFG, n=215, 21%) or diabetes (n=112, 11%) had a greater plaque burden, more coronary stenosis (>50% of diameter stenosis) and higher CACS than normal subjects (all, p<0.01). Noncalcified and mixed plaques were observed more in subjects with diabetes (19%) and IFG (11%) than normal (7%). After adjustment for confounding factors, higher fasting glucose was strongly associated with significant coronary stenosis and a greater plaque burden.

Conclusions

More significant coronary stenosis and multivessel involvement, higher CACS, and greater plaque burden were observed in subjects with IFG or diabetes by MDCT, even they are asymptomatic. Proactive screening, irrespective of the imaging modalities used, in asymptomatic subjects with prediabetes and diabetes is helpful to identify those who have a higher cardiovascular morbidity and mortality. Further studies will guide us with respect to which imaging modality is more appropriate.

Keywords: Multidetector-row computed tomography, Coronary artery calcium score, Coronary artery disease, Diabetes mellitus, Plaque characteristics