Utilization of serial intravascular ultrasound in the evaluation of cardiac transplant vasculopathy

Abstract

Introduction: Coronary artery disease (CAD) is the leading cause of morbidity and mortality in diabetic patients. It is unclear whether the coronary atherosclerotic plaque burden is similar in diabetics as in the general population. The aim of the study was to assess the differences in the presence, extent, and composition of coronary atherosclerotic plaque burden as detected by multislice computed tomography coronary angiography (MSCTA) in diabetic patients as compared to those with no diabetes. Methods: A total of 150 consecutive patients of whom 69 (46%) were diabetics underwent MSCTA. Study patients were classified as having no CAD, mild-moderate CAD (b50% stenosis), or moderate-severe CAD (N50% stenosis). Plaques were classified as calcific, noncalcific (mixed), or soft. Finally, patients were classified as having no CAD, having singlevessel CAD, and having more than one vessel CAD. Results: Diabetics less frequently had a normal MSCTA (36.2% vs. 59.3%, P=.008) and more frequently had obstructive plaques (43.5% vs. 18.5, P=.002). They had more calcific (0.83±1.2 vs. 0.28±0.71, P=.004) and noncalcific plaques (0.55±0.88 vs. 0.29±0.52, P=.048) and had more coronary arteries diseased (1.9±1.8 vs. 0.99±1.6, P=.001). Diabetes correlated with number of obstructive plaques (CI=1.6–7.1, P=.001), number of calcified plaques (CI=0.87–0.54, P=.001), and presence of multivessel disease (CI=2.41–10.27, P=.001). Conclusion: Diabetics have an overall increased coronary atherosclerotic plaque burden with approximately fourfold higher risk of coronary stenosis independent of other cardiovascular risk factors and a ninefold higher risk of multivessel CAD independent of other cardiovascular risk factors. Thus, MSCTmay be used to identify differences in coronary plaque burden, which may be useful for risk stratification. Abstracts / Cardiovascular Revascu