Diabetes Metab J.  2013 Feb;37(1):54-62. 10.4093/dmj.2013.37.1.54.

Diagnostic Accuracy of 64-Slice MDCT Coronary Angiography for the Assessment of Coronary Artery Disease in Korean Patients with Type 2 Diabetes

• Moon JS
• Yoon JS
• Won KC
• Cho IH
• Lee HW

• KMID: 2280743
• DOI: http://doi.org/10.4093/dmj.2013.37.1.54

Abstract

BACKGROUND
A 64-slice multidetector computed tomography (MDCT) is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM).
METHODS
A total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8+/-9.5 years). We compared significant coronary stenosis (>50% luminal narrowing) in MDCT with invasive coronary angiography (ICA) by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy.
RESULTS
Of the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109) were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226) were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222), 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74), 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (> or =25 kg/m2) and coronary calcium score did not also affect the diagnostic accuracy of MDCT.
CONCLUSION
The 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.

Keyword

Accuracy; Coronary artery disease; Diabetes mellitus, type 2; Multidetector computed tomography

MeSH Terms

Angiography
Arteries
Calcium
Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Coronary Vessels
Diabetes Mellitus, Type 2
Humans
Multidetector Computed Tomography
Obesity
Phenobarbital
Sensitivity and Specificity
Calcium
Phenobarbital

Figure

• 

  Fig. 1 We clinically classified patients with chest pain as having myocardial infarction, angina pectoris, or other according to changes in cardiac enzymes and electrocardiogram. Clinically, we classified unstable angina pectoris in patients as chest pain aggravated by exercise/exertion; otherwise, it was considered chronic stable angina pectoris. Variant angina pectoris and myocardial bridging were diagnosed based on characteristic findings on invasive coronary angiography. T2DM, type 2 diabetes; STEMI, ST elevation myocardiac infarction; NSTEMI, non-ST elevation myocardiac infarction; USAP, unstable angina pectoris; CSAP, chronic stable angina pectoris; VAP, variant angina pectoris.

Reference

1. Kim JH, Kim DJ, Jang HC, Choi SH. Epidemiology of micro- and macrovascular complications of type 2 diabetes in Korea. Diabetes Metab J. 2011. 35:571–577.

2. Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia. 2001. 44:Suppl 2. S14–S21.

3. Jacoby RM, Nesto RW. Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis. J Am Coll Cardiol. 1992. 20:736–744.

4. Lee KW. Costs of diabetes mellitus in Korea. Diabetes Metab J. 2011. 35:567–570.

5. Hammoud T, Tanguay JF, Bourassa MG. Management of coronary artery disease: therapeutic options in patients with diabetes. J Am Coll Cardiol. 2000. 36:355–365.

6. Bax JJ, Inzucchi SE, Bonow RO, Schuijf JD, Freeman MR, Barrett EJ. Cardiac imaging for risk stratification in diabetes. Diabetes Care. 2007. 30:1295–1304.

7. White CS, Kuo D, Kelemen M, Jain V, Musk A, Zaidi E, Read K, Sliker C, Prasad R. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation? AJR Am J Roentgenol. 2005. 185:533–540.

8. Rubinshtein R, Halon DA, Gaspar T, Jaffe R, Karkabi B, Flugelman MY, Kogan A, Shapira R, Peled N, Lewis BS. Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation. 2007. 115:1762–1768.

9. Gallagher MJ, Ross MA, Raff GL, Goldstein JA, O'Neill WW, O'Neil B. The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. Ann Emerg Med. 2007. 49:125–136.

10. Park JY, Lee KU, Kim CH, Kim HK, Hong SK, Park KS, Lee HK, Min HK. Past and current obesity in Koreans with non-insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1997. 35:49–56.

11. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004. 27:Suppl 1. S5–S10.

12. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation. 1975. 51:4 Suppl. 5–40.

13. Bassett J. International Diabetes Institute. World Health Organization Regional Office for the Western Pacific. International Association for the Study of Obesity. International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. 2000. Sydney: Health Communications Australia.

14. Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X, Waugh N. 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart. 2008. 94:1386–1393.

15. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, Paul N, Clouse ME, Shapiro EP, Hoe J, Lardo AC, Bush DE, de Roos A, Cox C, Brinker J, Lima JA. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008. 359:2324–2336.

16. McCulloch AC. Coronary angiography by 64-row CT. N Engl J Med. 2009. 360:2027.

17. Schuijf JD, Bax JJ, Jukema JW, Lamb HJ, Vliegen HW, Salm LP, de Roos A, van der Wall EE. Noninvasive angiography and assessment of left ventricular function using multislice computed tomography in patients with type 2 diabetes. Diabetes Care. 2004. 27:2905–2910.

18. Stein PD, Yaekoub AY, Matta F, Sostman HD. 64-slice CT for diagnosis of coronary artery disease: a systematic review. Am J Med. 2008. 121:715–725.

19. Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol. 2005. 46:552–557.

20. Dewey M, Vavere AL, Arbab-Zadeh A, Miller JM, Sara L, Cox C, Gottlieb I, Yoshioka K, Paul N, Hoe J, de Roos A, Lardo AC, Lima JA, Clouse ME. Patient characteristics as predictors of image quality and diagnostic accuracy of MDCT compared with conventional coronary angiography for detecting coronary artery stenoses: CORE-64 Multicenter International Trial. AJR Am J Roentgenol. 2010. 194:93–102.

21. Kim DM, Ahn CW, Nam SY. Prevalence of obesity in Korea. Obes Rev. 2005. 6:117–121.

22. Vogl TJ, Abolmaali ND, Diebold T, Engelmann K, Ay M, Dogan S, Wimmer-Greinecker G, Moritz A, Herzog C. Techniques for the detection of coronary atherosclerosis: multi-detector row CT coronary angiography. Radiology. 2002. 223:212–220.

23. Kuettner A, Kopp AF, Schroeder S, Rieger T, Brunn J, Meisner C, Heuschmid M, Trabold T, Burgstahler C, Martensen J, Schoebel W, Selbmann HK, Claussen CD. Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease. J Am Coll Cardiol. 2004. 43:831–839.

24. Kuettner A, Trabold T, Schroeder S, Feyer A, Beck T, Brueckner A, Heuschmid M, Burgstahler C, Kopp AF, Claussen CD. Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology: initial clinical results. J Am Coll Cardiol. 2004. 44:1230–1237.

25. Martuscelli E, Romagnoli A, D'Eliseo A, Razzini C, Tomassini M, Sperandio M, Simonetti G, Romeo F. Accuracy of thin-slice computed tomography in the detection of coronary stenoses. Eur Heart J. 2004. 25:1043–1048.

26. Gaudio C, Mirabelli F, Alessandra L, Nguyen BL, Di Michele S, Corsi F, Tanzilli G, Mancone M, Pannarale G, Francone M, Carbone I, Catalano C, Passariello R, Fedele F. Noninvasive assessment of coronary artery stenoses by multidetector-row spiral computed tomography: comparison with conventional angiography. Eur Rev Med Pharmacol Sci. 2005. 9:13–21.

27. Namgung J, Choe H, Kwon SU, Doh JH, Lee SY, Hur G, Lee WR. Diagnostic accuracy of 64-slice multidetector CT coronary angiography for the evaluation of coronary artery disease. Korean J Med. 2008. 75:42–53.

28. Yun YK, Park KH, Choi YS, Kim KM, Jun TG, Kim JG. Computerized quantative analysis of cornary angiogram in patients without coronary pathology. Korean J Thorac Cardiovasc Surg. 1998. 31:488–493.

29. Chu ZG, Yang ZG, Dong ZH, Zhu ZY, Deng W, Peng LQ, Shao H, Tang SS, Chen J. Comparative analysis of coronary artery disease assessed by coronary CT angiography between patients with type 2 diabetes mellitus and non-diabetic patients. Int J Cardiol. 2011. 147:178–181.

30. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007. 298:317–323.