Open Access Research article

Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics?: results of a long term follow-up

Ana Faustino1*, Rui Providência1, Paula Mota1, Sérgio Barra1, Joana Silva1, Andreia Fernandes1, Rui Catarino2, Susana Basso2, Marco Costa1 and António Leitão-Marques1

Author Affiliations

1 Cardiology Department, Coimbra’s Hospital and University Centre – General Hospital, Coimbra, Portugal

2 Radiology Department, Coimbra’s Hospital and University Centre – General Hospital, Quinta dos Vales, Martinho do Bispo, Coimbra 3041-801 S, Portugal

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BMC Cardiovascular Disorders 2014, 14:2  doi:10.1186/1471-2261-14-2

Published: 8 January 2014

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords:
Cardiac computed tomography; Coronary artery calcium; Coronary CT angiography; Cardiovascular risk; Type-2 diabetes; Coronary artery disease