Abstract
BackgroundDiabetics have high prevalence of subclinical coronary artery disease (CAD) with typical characteristics (diffuse disease, large calcifications). Although 64-slice multidetector computed tomography (MDCT) coronary angiography has high diagnostic accuracy to detect CAD, its diagnostic performance in diabetics with suspected CAD is unknown. To compare the diagnostic performance of 64-slice MDCT between diabetics and non-diabetics with suspected CAD scheduled for invasive coronary angiography (ICA).MethodsWe enrolled one hundred and five diabetic patients (92 men, age 65 +/- 9 years, Group 1) and 105 non-diabetic patients (63 men, age 63+/-5 years, Group 2) with indication to ICA for suspected CAD undergoing coronary 64-slice MDCT before ICA.ResultsIn Group 1, the overall feasibility of coronary artery visualization was 93.8%. The most frequent artifact was blooming due to large coronary calcifications (54 artifacts, 67%). In Group 2, the overall feasibility was significantly higher vs. Group 1 (97%, p < 0.0001). In Group 1, the segment-based analysis showed a MDCT sensibility, specificity, positive predictive value, negative predictive value and accuracy for the detection of ≥50% luminal narrowing of 77%, 90%, 70%, 93% and 87%, respectively. In Group 2, all these parameters were significantly higher vs. Group 1. In the patient-based analysis, specificity, negative predictive value and accuracy were significantly lower in Group 1 vs. Group 2.ConclusionsAlthough MDCT has high sensitivity for early identification of significant CAD in diabetics, its diagnostic performance is significantly reduced in these patients as compared to non-diabetics with similar clinical characteristics.
Highlights
Diabetics have high prevalence of subclinical coronary artery disease (CAD) with typical characteristics
Iwasaki et al demonstrated that the prevalence of subclinical atherosclerosis in asymptomatic diabetes mellitus (DM) patients assessed with 64-slice multidetector computed tomography (MDCT) is higher than that observed in asymptomatic non-diabetic patients
The diagnostic accuracy of MDCT in diabetics can be influenced by two main problems: the increased pretest likelihood of CAD that affects lower diagnostic performance of MDCT [8,9], and the coronary artery lesions characteristically located in smaller vessels [10] and more frequently presenting extensive calcifications [3,6,11]
Summary
Diabetics have high prevalence of subclinical coronary artery disease (CAD) with typical characteristics (diffuse disease, large calcifications). The diagnostic accuracy of MDCT in diabetics can be influenced by two main problems: the increased pretest likelihood of CAD that affects lower diagnostic performance of MDCT [8,9], and the coronary artery lesions characteristically located in smaller vessels [10] and more frequently presenting extensive calcifications [3,6,11]. These are the main causes of unevaluability of coronary arteries at MDCT [12]. The aim of this study was to compare the diagnostic performance of 64-slice MDCT between DM patients and a control population with suspected but unknown CAD scheduled for invasive coronary angiography (ICA)
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