Background
Methods
Study population
Group 1 Diabetic Patients | Group 2 Control group | p | |
---|---|---|---|
Number of patients, n | 105 | 105 | ns |
Gender (male/female),n | 92/13 | 92/13 | ns |
Age (years), mean ± SD | 65.4 ± 9.4 | 63.3 ± 5.5 | ns |
BMI (Kg/m2), mean ± SD | 28.3 ± 3.4 | 28. ± 5 4 | ns |
Serum creatinine (mg/dl), mean ± SD | 1.12 ± 0.3 | 1.04 ± 0.2 | ns |
CLINICAL HISTORY | |||
Angina, n (%) | 54 (51%) | 62 (59%) | ns |
Inconclusive stress test, n(%) | 56 (53%) | 62 (58%) | ns |
Valvular disease, n (%) | 0 (0%) | 2 (2%) | ns |
Arrhytmia, n (%) | 0 (0%) | 2 (2%) | ns |
DCM, n (%) | 12 (8%) | 10 (9.5%) | ns |
CARDIOVASCULAR RISK FACTORS | |||
Diabetes mellitus, n (%) | 105 (100%) | 0 (0%) | 0.01 |
Insulin dependent, n (%) | 12 (11.5%) | - | - |
Glycosylated haemoglobin (%) | 7.1 ± 2.4% | - | - |
Hypertension, n (%) | 74 (70%) | 63 (60%) | ns |
Hypercholesterolemia, n (%) | 59 (56%) | 45 (43%) | ns |
Current smoking, n (%) | 31 (30%) | 29 (28%) | ns |
Family history of CAD, n (%) | 21 (20%) | 27 (26%) | ns |
PRE-TEST LIKELIHOOD OF CAD | 51% | 52% | ns |
β-BLOCKER | |||
Number of patients, n (%) | 66 (63%) | 63 (60%) | ns |
Dose (mg), mean ± SD | 11.2 ± 5.3 | 11.4 ± 2.5 | ns |
HEART RATE (bpm), mean ± SD | 61.2 ± 9.3 | 58 ± 4.6 | ns |
AGATSTON SCORE | |||
mean ± SD | 479 ± 492 | 356 ± 367 | 0.01 |
median (range) | 346 (0-1740) | 240 (0-1650) | 0.01 |
CAD extension | |||
0-vessel, n (%) | 10 (11%) | 18 (13%) | ns |
1-vessel, n (%) | 28 (27%) | 20 (19%) | ns |
2-vessel, n (%) | 33 (30%) | 34 (34%) | ns |
3-vessel, n (%) | 34 (32%) | 33 (34%) | ns |
Patient preparation for 64-slice MDCT coronary angiography
Scan protocol
MDCT image analysis
Invasive coronary angiography
Statistical analysis
Results
Baseline characteristics
MDCT feasibility
N° | Feasibility n (%) | Breath n (%) | SM n (%) | Ca n (%) | S/N n (%) | CD n (%) | |
---|---|---|---|---|---|---|---|
GROUP 1 Segments
| 1310 | 1229 (94%) | 11 (13%) | 13 (16%) | 54 (67%) | 3 (4%) | - |
GROUP 2 Segments
| 1342 | 1303 (97%) | 13 (33%) | 10 (26%) | 14 (36%) | 2 (6%) | - |
P
| - | 0.0001 | NS | NS | 0.0001 | NS | - |
CAD imaging with MDCT
Coronary size
Segments | Lumen Diameter in Group 1 | Lumen Diameter in Group 2 | P values |
---|---|---|---|
LM (mean ± SD, mm)
| 4,0 ± 0,3 | 4,2 ± 0,4 |
0.0001
|
Proximal LAD (mean ± SD, mm)
| 3,5 ± 0,4 | 3,8 ± 0,2 |
0.0001
|
Mid LAD (mean ± SD, mm)
| 2,8 ± 0,1 | 2,8 ± 0,2 |
0.30
|
Distal LAD (mean ± SD, mm)
| 1,8 ± 0,2 | 2,3 ± 0,4 |
0.0001
|
D1 (mean ± SD, mm)
| 1,7 ± 0,3 | 2,6 ± 0,5 |
0.0001
|
D2 (mean ± SD, mm)
| 1,6 ± 0,1 | 2,5 ± 0,5 |
0.0001
|
Proximal LCX (mean ± SD, mm)
| 3,0 ± 0,1 | 3,0 ± 0,4 |
0.56
|
Mid LCX (mean ± SD, mm)
| 2,5 ± 0,3 | 2,8 ± 0,5 |
0.008
|
Distal LCX (mean ± SD, mm)
| 2,4 ± 0,2 | 2,3 ± 0,5 |
0.001
|
M1 (mean ± SD, mm)
| 2,5 ± 0,4 | 2,7 ± 0,5 |
0.0001
|
M2 (mean ± SD, mm)
| 1,8 ± 0,5 | 2,4 ± 0,4 |
0.0001
|
Proximal RCA (mean ± SD, mm)
| 3,0 ± 0,2 | 3,9 ± 0,5 |
0.0001
|
Distal RCA (mean ± SD, mm)
| 2,8 ± 0,2 | 3,4 ± 0,5 |
0.0001
|
PLA (mean ± SD, mm)
| 2,5 ± 0,2 | 2,8 ± 0,4 |
0.0001
|
PDA (mean ± SD, mm)
| 2,6 ± 0,2 | 3,0 ± 0,4 |
0.0001
|
MDCT accuracy in a segment-based model Group 1
Segments | N | TN | TP | FN | FP | Se | Sp | NPV | PPV | Accuracy |
---|---|---|---|---|---|---|---|---|---|---|
LM
| 99 | 85 | 1 | 7 | 6 | 13% | 93% | 92% | 14% | 87% |
Proximal LAD
| 99 | 44 | 43 | 0 | 12 | 100% | 79% | 100% | 78% | 88% |
Mid LAD
| 93 | 40 | 38 | 7 | 8 | 84% | 83% | 85% | 83% | 84% |
Distal LAD
| 98 | 86 | 6 | 4 | 2 | 60% | 98% | 96% | 75% | 94% |
D1
| 80 | 48 | 15 | 6 | 11 | 71% | 81% | 89% | 58% | 79% |
D2
| 58 | 52 | 1 | 1 | 4 | 50% | 93% | 98% | 20% | 91% |
Proximal LCX
| 101 | 65 | 22 | 3 | 11 | 88% | 86% | 96% | 67% | 86% |
Mid LCX
| 95 | 70 | 16 | 4 | 5 | 80% | 93% | 95% | 76% | 91% |
Distal LCX
| 92 | 84 | 3 | 2 | 3 | 60% | 97% | 98% | 50% | 95% |
M1
| 76 | 54 | 8 | 7 | 7 | 53% | 89% | 89% | 53% | 82% |
M2
| 17 | 14 | 2 | 1 | 0 | 67% | 100% | 93% | 100% | 94% |
Proximal RCA
| 91 | 47 | 25 | 11 | 8 | 69% | 85% | 81% | 76% | 79% |
Distal RCA
| 89 | 44 | 28 | 8 | 9 | 83% | 78% | 85% | 76% | 83% |
PLA
| 64 | 52 | 6 | 2 | 4 | 75% | 93% | 96% | 60% | 91% |
PDA
| 77 | 66 | 2 | 7 | 2 | 22% | 97% | 90% | 50% | 88% |
All segments
| 1229 | 851 | 218 | 69 | 91 | 76% (72-82) | 90% (88-92) | 93% (91-94) | 71% (65-73) | 87% (86-90) |
Group 2
Segments | N | TN | TP | FN | FP | Se | Sp | NPV | PPV | Accuracy |
---|---|---|---|---|---|---|---|---|---|---|
LM
| 104 | 99 | 4 | 1 | 0 | 80% | 100% | 99% | 100% | 99% |
Proximal LAD
| 94 | 46 | 45 | 1 | 2 | 98% | 96% | 98% | 96% | 97% |
Mid LAD
| 91 | 44 | 42 | 1 | 4 | 98% | 92% | 98% | 91% | 94% |
Distal LAD
| 99 | 86 | 10 | 2 | 1 | 83% | 99% | 98% | 91% | 97% |
D1
| 86 | 66 | 19 | 0 | 1 | 100% | 98% | 100% | 95% | 99% |
D2
| 30 | 27 | 3 | 0 | 0 | 100% | 100% | 100% | 100% | 100% |
Proximal LCX
| 96 | 70 | 17 | 3 | 6 | 85% | 92% | 96% | 74% | 91% |
Mid LCX
| 94 | 72 | 18 | 2 | 2 | 90% | 97% | 97% | 90% | 96% |
Distal LCX
| 101 | 89 | 8 | 2 | 2 | 80% | 98% | 98% | 80% | 96% |
M1
| 89 | 72 | 9 | 2 | 6 | 82% | 92% | 97% | 60% | 91% |
M2
| 24 | 19 | 2 | 0 | 3 | 100% | 86% | 100% | 40% | 88% |
Proximal RCA
| 99 | 66 | 28 | 0 | 5 | 100% | 93% | 100% | 85% | 95% |
Distal RCA
| 96 | 66 | 25 | 3 | 2 | 89% | 97% | 96% | 93% | 95% |
PLA
| 100 | 85 | 12 | 1 | 2 | 92% | 98% | 99% | 86% | 97% |
PDA
| 100 | 87 | 9 | 3 | 1 | 75% | 99% | 97% | 90% | 96% |
All segments
| 1303 | 994 | 251 | 21 | 37 | 92% (87-94) | 96% (94-97) | 98% (96-99) | 87% (86-89) | 96% (93-97) |
Comparison of MDCT diagnostic accuracy in a segment-based model
SEGMENT-BASED MODEL - SEGMENTS FOR ANALYSIS ONLY | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Group | N° | TN | TP | FN | FP | Se | Sp | NPV | PPV | Accuracy |
Group 1
| 1229 | 851 | 218 | 69 | 91 | 76% (72-82) | 90% (88-92) | 93% (91-94) | 71% (65-73) | 87% (86-89) |
Group 2
| 1303 | 994 | 251 | 21 | 37 | 92% (87-94) | 96% (94-97) | 98% (96-99) | 87% (86-89) | 96% (93-97) |
P
| - | - | - | - | - | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 |
SEGMENT-BASED MODEL - ALL SEGMENTS FOR ANALYSIS WITH NON EVALUABLE SEGMENTS "POSITIVE"
| ||||||||||
Group
|
N
|
TN
|
TP
|
FN
|
FP
|
Se
|
Sp
|
NPV
|
PPV
|
Accuracy
|
Group 1
| 1310 | 851 | 243 | 69 | 147 | 78% (73-82) | 85% (83-87) | 92% (91-94) | 62% (57-65) | 83% (81-85) |
Group 2
| 1342 | 994 | 251 | 21 | 76 | 92% (89-95) | 93% (91-94) | 98% (97-99) | 77% (81-92) | 93% (91-94) |
P
| - | - | - | - | - | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 |
PATIENT-BASED MODEL - SEGMENTS FOR ANALYSIS ONLY
| ||||||||||
Group
|
N°
|
TN
|
TP
|
FN
|
FP
|
Se
|
Sp
|
NPV
|
PPV
|
Accuracy
|
Group 1
| 105 | 3 | 87 | 6 | 9 | 94% (89-99) | 33% (0-51) | 25% (0-90) | 91% (85-100) | 86% (82-88) |
Group 2
| 105 | 15 | 83 | 4 | 3 | 95% (91-100) | 83% (66-100) | 79% (61-97) | 97% (93-100) | 93% (89-98) |
P
| - | - | - | - | - | NS | 0.01 | 0.001 | NS | 0.05 |