Type 2 diabetes mellitus is associated with a lower fibrous cap thickness but has no impact on calcification morphology: an ... View Full Text


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Article Info

DATE

2017-12-01

AUTHORS

Andrea Milzi, Mathias Burgmaier, Kathrin Burgmaier, Martin Hellmich, Nikolaus Marx, Sebastian Reith

ABSTRACT

BackgroundPatients with type 2 diabetes (T2DM) are at high risk for cardiovascular events, which usually arise from the rupture of a vulnerable coronary plaque. The minimal fibrous cap thickness (FCT) overlying a necrotic lipid core is an established predictor for plaque rupture. Recently, coronary calcification has emerged as a relevant feature of plaque vulnerability. However, the impact of T2DM on these morphological plaque parameters is largely unexplored. Therefore, this study aimed to compare differences of coronary plaque morphology in patients with and without T2DM with a particular focus on coronary calcification.MethodsIn 91 patients (T2DM = 56, non-T2DM = 35) with 105 coronary de novo lesions (T2DM = 56, non-T2DM = 49) plaque morphology and calcification were analyzed using optical coherence tomography (OCT) prior to coronary intervention.ResultsPatients with T2DM had a lower minimal FCT (80.4 ± 27.0 µm vs. 106.8 ± 27.8 µm, p < 0.001) and a higher percent area stenosis (77.9 ± 8.1% vs. 71.7 ± 11.2%, p = 0.001) compared to non-diabetic subjects. However, patients with and without T2DM had a similar total number of calcifications (4.0 ± 2.6 vs. 4.2 ± 3.1, p = ns) and no significant difference was detected in the number of micro- (0.34 ± 0.79 vs. 0.31 ± 0.71), spotty (2.11 ± 1.77 vs. 2.37 ± 1.89) or macro-calcifications (1.55 ± 1.13 vs. 1.53 ± 0.71, all p = ns). The mean calcium arc (82.3 ± 44.8° vs. 73.7 ± 31.6), the mean thickness of calcification (0.54 ± 0.13 mm vs. 0.51 ± 0.15 mm), the mean calcified area (0.99 ± 0.72 mm2 vs. 0.78 ± 0.49 mm2), the mean depth of calcification (172 ± 192 μm vs. 160 ± 76 μm) and the cap thickness overlying the calcification (50 ± 71 μm vs. 62 ± 61 μm) did not differ between the diabetic and non-diabetic groups (all p = ns).ConclusionT2DM has an impact on the minimal FCT of the coronary target lesion, but not on localization, size, shape or extent of calcification. Thus, the minimal FCT overlying the necrotic lipid core but not calcification is likely to contribute to the increased plaque vulnerability observed in patients with T2DM. More... »

PAGES

152

References to SciGraph publications

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        "description": "BackgroundPatients with type 2 diabetes (T2DM) are at high risk for cardiovascular events, which usually arise from the rupture of a vulnerable coronary plaque. The minimal fibrous cap thickness (FCT) overlying a necrotic lipid core is an established predictor for plaque rupture. Recently, coronary calcification has emerged as a relevant feature of plaque vulnerability. However, the impact of T2DM on these morphological plaque parameters is largely unexplored. Therefore, this study aimed to compare differences of coronary plaque morphology in patients with and without T2DM with a particular focus on coronary calcification.MethodsIn 91 patients (T2DM\u00a0=\u00a056, non-T2DM\u00a0=\u00a035) with 105 coronary de novo lesions (T2DM\u00a0=\u00a056, non-T2DM\u00a0=\u00a049) plaque morphology and calcification were analyzed using optical coherence tomography (OCT) prior to coronary intervention.ResultsPatients with T2DM had a lower minimal FCT (80.4\u00a0\u00b1\u00a027.0\u00a0\u00b5m vs. 106.8\u00a0\u00b1\u00a027.8\u00a0\u00b5m, p\u00a0<\u00a00.001) and a higher percent area stenosis (77.9\u00a0\u00b1\u00a08.1% vs. 71.7\u00a0\u00b1\u00a011.2%, p\u00a0=\u00a00.001) compared to non-diabetic subjects. However, patients with and without T2DM had a similar total number of calcifications (4.0\u00a0\u00b1\u00a02.6 vs. 4.2\u00a0\u00b1\u00a03.1, p\u00a0=\u00a0ns) and no significant difference was detected in the number of micro- (0.34\u00a0\u00b1\u00a00.79 vs. 0.31\u00a0\u00b1\u00a00.71), spotty (2.11\u00a0\u00b1\u00a01.77 vs. 2.37\u00a0\u00b1\u00a01.89) or macro-calcifications (1.55\u00a0\u00b1\u00a01.13 vs. 1.53\u00a0\u00b1\u00a00.71, all p\u00a0=\u00a0ns). The mean calcium arc (82.3\u00a0\u00b1\u00a044.8\u00b0\u00a0vs. 73.7 \u00b1\u00a031.6), the mean thickness of calcification (0.54\u00a0\u00b1\u00a00.13\u00a0mm vs. 0.51\u00a0\u00b1\u00a00.15\u00a0mm), the mean calcified area (0.99\u00a0\u00b1\u00a00.72\u00a0mm2 vs. 0.78\u00a0\u00b1\u00a00.49\u00a0mm2), the mean depth of calcification (172\u00a0\u00b1\u00a0192\u00a0\u03bcm vs. 160\u00a0\u00b1\u00a076\u00a0\u03bcm) and the cap thickness overlying the calcification (50\u00a0\u00b1\u00a071\u00a0\u03bcm vs. 62\u00a0\u00b1\u00a061\u00a0\u03bcm) did not differ between the diabetic and non-diabetic groups (all p\u00a0=\u00a0ns).ConclusionT2DM has an impact on the minimal FCT of the coronary target lesion, but not on localization, size, shape or extent of calcification. Thus, the minimal FCT overlying the necrotic lipid core but not calcification is likely to contribute to the increased plaque vulnerability observed in patients with T2DM.", 
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    33 schema:description BackgroundPatients with type 2 diabetes (T2DM) are at high risk for cardiovascular events, which usually arise from the rupture of a vulnerable coronary plaque. The minimal fibrous cap thickness (FCT) overlying a necrotic lipid core is an established predictor for plaque rupture. Recently, coronary calcification has emerged as a relevant feature of plaque vulnerability. However, the impact of T2DM on these morphological plaque parameters is largely unexplored. Therefore, this study aimed to compare differences of coronary plaque morphology in patients with and without T2DM with a particular focus on coronary calcification.MethodsIn 91 patients (T2DM = 56, non-T2DM = 35) with 105 coronary de novo lesions (T2DM = 56, non-T2DM = 49) plaque morphology and calcification were analyzed using optical coherence tomography (OCT) prior to coronary intervention.ResultsPatients with T2DM had a lower minimal FCT (80.4 ± 27.0 µm vs. 106.8 ± 27.8 µm, p < 0.001) and a higher percent area stenosis (77.9 ± 8.1% vs. 71.7 ± 11.2%, p = 0.001) compared to non-diabetic subjects. However, patients with and without T2DM had a similar total number of calcifications (4.0 ± 2.6 vs. 4.2 ± 3.1, p = ns) and no significant difference was detected in the number of micro- (0.34 ± 0.79 vs. 0.31 ± 0.71), spotty (2.11 ± 1.77 vs. 2.37 ± 1.89) or macro-calcifications (1.55 ± 1.13 vs. 1.53 ± 0.71, all p = ns). The mean calcium arc (82.3 ± 44.8° vs. 73.7 ± 31.6), the mean thickness of calcification (0.54 ± 0.13 mm vs. 0.51 ± 0.15 mm), the mean calcified area (0.99 ± 0.72 mm2 vs. 0.78 ± 0.49 mm2), the mean depth of calcification (172 ± 192 μm vs. 160 ± 76 μm) and the cap thickness overlying the calcification (50 ± 71 μm vs. 62 ± 61 μm) did not differ between the diabetic and non-diabetic groups (all p = ns).ConclusionT2DM has an impact on the minimal FCT of the coronary target lesion, but not on localization, size, shape or extent of calcification. Thus, the minimal FCT overlying the necrotic lipid core but not calcification is likely to contribute to the increased plaque vulnerability observed in patients with T2DM.
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    39 schema:keywords BackgroundPatients
    40 ResultsPatients
    41 T2DM
    42 arc
    43 area
    44 area stenosis
    45 calcification
    46 calcification morphology
    47 calcified areas
    48 calcium arc
    49 cap thickness
    50 cardiovascular events
    51 coherence tomography
    52 core
    53 coronary calcification
    54 coronary intervention
    55 coronary plaque morphology
    56 coronary plaques
    57 depth
    58 diabetes
    59 diabetes mellitus
    60 differences
    61 events
    62 extent
    63 extent of calcification
    64 features
    65 fibrous cap thickness
    66 focus
    67 group
    68 high risk
    69 impact
    70 impact of T2DM
    71 intervention
    72 lesions
    73 lipid core
    74 localization
    75 mean depth
    76 mean thickness
    77 mellitus
    78 micro
    79 minimal fibrous cap thickness
    80 morphology
    81 necrotic lipid core
    82 non-diabetic group
    83 non-diabetic subjects
    84 number
    85 number of micro
    86 optical coherence tomography
    87 optical coherence tomography study
    88 parameters
    89 particular focus
    90 patients
    91 percent area stenosis
    92 plaque morphology
    93 plaque parameters
    94 plaque rupture
    95 plaque vulnerability
    96 plaques
    97 predictors
    98 relevant features
    99 risk
    100 rupture
    101 shape
    102 significant differences
    103 similar total number
    104 size
    105 stenosis
    106 study
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