The online version of this article (doi:10.1186/1471-2261-14-2) contains supplementary material, which is available to authorized users.
The authors have no competing interests.
AF: conception and design, acquisition, analysis and interpretation of data, draft of the manuscript; PM: conception and design, acquisition and interpretation of CT images, analysis and interpretation of data, critical review of the manuscript; JS: conception and design, acquisition of data, critical review of the manuscript; RP: analysis and interpretation of data, critical review of the manuscript; SB: critical review of the manuscript; AFF: acquisition of data; RC: acquisition and interpretation of CT images; SB: acquisition and interpretation of CT images; MC: have given final approval of the version to be published; ALM: have given final approval of the version to be published. All authors read and approved the final manuscript.
Doubts remain about atherosclerotic disease and risk stratification of asymptomatic type-2 diabetic patients (T2DP). This study aims to evaluate the usefulness of calcium score (CS) and coronary computed tomography (CT) angiography (CTA) to predict fatal and non fatal cardiovascular events (CVEV) in T2DP.
Eighty-five consecutive T2DP undergoing CT (Phillips Brilliance, 16-slice) with CS and CTA were prospectively enrolled in a transversal case-control study. Patients were followed for 48 months (range 18 - 68) to assess CVEV: cardiovascular death, acute coronary syndrome, revascularisation and stroke. Potential predictors of CVEV were identified. Predictive models based on clinical features, CTA and CS were created and compared.
Performing CT impacted T2DP treatment. Cardiovascular risk was lowered during follow-up but metabolic control remained suboptimal. CVEV occurred in 11.8% T2DP (3.1%/year). CS ≥86.6 was predictor of CVEV over time, with a high negative predictive value, an 80% sensitivity and 74.7% specificity. Although its prognostic value was not independent of the presence/absence of obstructive CAD, adding CS and CTA data to clinical parameters improved the prediction of CVEV: the combined model had the highest AUC (0.888, 95%CI 0.789-0.987, p < 0.001) for the prediction of the study endpoints.
CS showed great value in T2DP risk stratification and its prognostic value was further enhanced by CTA data. Information provided by CT may help predict CVEV in T2DP and potentially improve their outcome.
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- Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics?: results of a long term follow-up
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