Use of imaging and clinical data to screen for cardiovascular disease in asymptomatic diabetics.
Autor: | Rassi CH; Heart Institute (InCor), University of São Paulo, Medical School, Brazil, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. carloshrer@uol.com.br., Churchill TW; Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. twchurchill@partners.org., Tavares CA; Heart Institute (InCor), University of São Paulo, Medical School, Brazil, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. fernandes-tavares@ig.com.br., Fahel MG; Heart Institute (InCor), University of São Paulo, Medical School, Brazil, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. mateusfahel@gmail.com., Rassi FP; Heart Institute (InCor), University of São Paulo, Medical School, Brazil, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. fabriciarassi@gmail.com., Uchida AH; Heart Institute (InCor), University of São Paulo, Medical School, Brazil, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. augusto.uchida@gmail.com., Wajchenberg BL; Heart Institute (InCor), University of São Paulo, Medical School, Brazil, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. bernarwaj@globo.com., Lerario AC; Heart Institute (InCor), University of São Paulo, Medical School, Brazil, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. aclerario@terra.com.br., Hulten E; Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. ehulten@partners.org., Nasir K; Department of Cardiology, Baptist Health South Florida, 8900 N. Kendall Drive, Miami, FL, 33176, USA. knasir1@jhmi.edu., Bittencourt MS; Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. msbittencourt@mail.harvard.edu.; Center for Clinical and Epidemiological Research, Division of Internal Medicine, University Hospital, and State of São Paulo Cancer Institute (ICESP), University of São Paulo, São Paulo, Brazil. msbittencourt@mail.harvard.edu., Rochitte CE; Heart Institute (InCor), University of São Paulo, Medical School, Brazil, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil. rochitte@incor.usp.br., Blankstein R; Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. rblankstein@partners.org. |
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Jazyk: | angličtina |
Zdroj: | Cardiovascular diabetology [Cardiovasc Diabetol] 2016 Feb 09; Vol. 15, pp. 28. Date of Electronic Publication: 2016 Feb 09. |
DOI: | 10.1186/s12933-016-0334-4 |
Abstrakt: | Background: There is increasing evidence to suggest that not all individuals with type 2 diabetes mellitus (T2DM) have equal risk for developing cardiovascular disease. We sought to compare the yield of testing for pre-clinical atherosclerosis with various approaches. Methods: 98 asymptomatic individuals with T2DM without known coronary artery disease (CAD) were enrolled in a prospective study and underwent carotid ultrasound, exercise treadmill testing (ETT), coronary artery calcium (CAC) scoring, and coronary computed tomography angiography (CTA). Results: Of 98 subjects (average age 55 ± 6, 64 % female), 43 (44 %) had coronary plaque detectable on CTA, and 38 (39 %) had CAC score >0. By CTA, 16 (16 %) had coronary stenosis ≥50 %, including three subjects with CAC = 0. Subjects with coronary plaque had greater prevalence of carotid plaque (58 % vs. 38 %, p = 0.01) and greater carotid intima media thickness (0.80 ± 0.20 mm vs. 0.70 ± 0.11 mm, p = 0.02). Notably, 18 of 55 subjects (33 %) with normal CTA had carotid plaque. Eight subjects had a positive ETT, of whom five had ≥ 50 % coronary stenosis, two had <50 % stenosis, and one had no CAD. Among these tests, CAC scoring had the highest sensitivity and specificity for prediction of CAD. Conclusion: Among asymptomatic subjects with T2DM, a majority (56 %) had no CAD by CTA. When compared to CTA, CAC was the most accurate screening modality for detection of CAD, while ETT and carotid ultrasound were less sensitive and specific. However, 33 % of subjects with normal coronary CTA had carotid plaque, suggesting that screening for carotid plaque might better characterize stroke risk in such patients. |
Databáze: | MEDLINE |
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