Coronary Atherosclerotic Plaque Detected by Computed Tomographic Angiography in Subjects with Diabetes Compared to Those without Diabetes.
Coronary Atherosclerotic Plaque Detected by Computed Tomographic Angiography in Subjects with Diabetes Compared to Those without Diabetes.
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DOI：
10.1371/journal.pone.0143187
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Budoff MJ
中科院分区：
文献类型：
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作者：
Khazai B;Luo Y;Rosenberg S;Wingrove J;Budoff MJ
关于糖尿病患者冠状动脉斑块组成和半定量评分的数据很少;糖尿病可能影响冠状动脉钙（CAC）的存在和程度的程度需要更多的评估。考虑到这些信息可能对制定该人群的预防干预措施具有重要价值，我们比较了糖尿病患者与非糖尿病患者的这些发现。使用15-冠状动脉节段模型评价了2000年1月至2012年9月期间转诊至洛杉矶生物医学研究所的861例连续糖尿病患者的多探测器计算机断层扫描（MDCT）图像。所有861例患者均进行了钙评分，其中389例进行了冠状动脉CT血管造影（CTA）。CAC评分与861名年龄、性别和种族匹配的无糖尿病对照组进行比较，调整体重指数（BMI）、冠状动脉疾病家族史、高脂血症、高血压和吸烟。细分市场参与评分（SIS;有任何斑块的节段总数），节段狭窄评分（SSS;每个节段的最大狭窄评分总和），总斑块评分（租置计划;每段斑块量的总和）和斑块组成与389名年龄、性别和种族匹配的无糖尿病对照组进行比较，调整BMI，冠心病家族史，高脂血症，高血压和吸烟。糖尿病与CAC的存在和程度呈正相关（P<0.0001）。糖尿病组SIS、SSS、TPS明显高于对照组（P<0.0001）。糖尿病组混合斑块和钙化斑块明显多于对照组（P = 0.018和P<0.001），而非钙化斑块两组间差异无统计学意义（P = 0.398）。在调整心血管危险因素后，与年龄、性别和种族匹配的无糖尿病对照组相比，糖尿病患者的CAC和半定量冠状动脉斑块评分较高。由于混合斑块与更差的长期临床结局相关，这些发现支持在该人群中采取更积极的预防措施。
Little data are available regarding coronary plaque composition and semi-quantitative scores in individuals with diabetes; the extent to which diabetes may affect the presence and extent of Coronary Artery Calcium (CAC) needs more evaluation. Considering that this information may be of great value in formulating preventive interventions in this population, we compared these findings in individuals with diabetes to those without. Multi-Detector Computed Tomographic (MDCT) images of 861 consecutive patients with diabetes who were referred to Los Angeles Biomedical Research Institute from January 2000 to September 2012, were evaluated using a 15–coronary segment model. All 861 patients underwent calcium scoring and from these; 389 had coronary CT angiography (CTA). CAC score was compared to 861 age, sex and ethnicity matched controls without diabetes after adjustment for Body Mass Index (BMI), family history of coronary artery disease, hyperlipidemia, hypertension and smoking. Segment Involvement Score (SIS; the total number of segments with any plaque), Segment Stenosis Score (SSS; the sum of maximal stenosis score per segment), Total Plaque Score (TPS; the sum of the plaque amount per segment) and plaque compositionwere compared to 389 age, sex and ethnicity matched controls without diabetes after adjustment for BMI, family history of coronary artery disease, hyperlipidemia, hypertension and smoking. Diabetes was positively correlated to the presence and extent of CAC (P<0.0001 for both). SIS, SSS and TPS were significantly higher in those with diabetes (P<0.0001). Number of mixed and calcified plaques were significantly higher in those with diabetes (P = 0.018 and P<0.001 respectively) but there was no significant difference in the number of non-calcified plaques between the two groups (P = 0.398). Patients with diabetes have higher CAC and semi-quantitative coronary plaque scores compared to the age, gender and ethnicity matched controls without diabetes after adjustment for cardiovascular risk factors. Since mixed plaque is associated with worse long-term clinical outcomes, these findings support more aggressive preventive measures in this population.