Coronary Calcification in Long-term Type 1 Diabetic Patients - A Study with Multi Slice Spiral Computed Tomography

1. The distensibility of the resistance vessels of the skin at the dorsum of the foot was determined in 11 long-term type 1 (insulin-dependent) diabetic patients with nephropathy and retinopathy, nine short-term type 1 diabetic patients without clinical microangiopathy and in nine healthy non-diabetic subjects. 2. Blood flow was measured by the local 133Xexenon washout technique in a vascular bed locally paralysed by the injection of histamine. Blood flow was measured before, during and after a 40 mmHg increase of the vascular transmural pressure, induced by head-up tilt. 3. The mean increase in blood flow during headup tilt was only 24% in diabetic subjects with and 48% in diabetic patients without clinical microangiopathy, compared with 79% in normal non-diabetic subjects (P < 0.0005 and P < 0.05, respectively). 4. An inverse correlation between microvascular distensibility and degree of hyalinosis of the terminal arterioles in biopsies from the skin was demonstrated (r = − 0.57, P < 0.001). 5. Our results suggest that terminal arteriolar hyalinosis reduces the microvascular distensibility and probably increases the minimal vascular resistance, thereby impeding hyperaemic responses.

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Abstract 2764: The Advantages of using Multi-slice Spiral Computed Tomography to Evaluate Serious Coronary Complications in Adolescents after Kawasaki Disease

Circulation ◽

10.1161/circ.116.suppl_16.ii_613-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Hiroshi Kanamaru ◽

Kensuke Karasawa ◽

Rie Ichikawa ◽

Osamu Abe ◽

Michio Miyashita ◽

...

Keyword(s):

Computed Tomography ◽

Kawasaki Disease ◽

Coronary Calcification ◽

Spiral Computed Tomography ◽

Spiral Computed ◽

Main Trunk ◽

Diagnostic Modality ◽

Stenotic Lesion ◽

Coronary Aneurysms ◽

Stenotic Lesions

Objectives We identified novel multi-slice spiral computed tomography (MSCT) findings in adolescents after Kawasaki disease that could not be detected by coronary angiography (CAG). Methods We studied 18 patients who had suffered from serious coronary arterial lesions after Kawasaki disease (mean age: 21.7 years; range: 13 to 34 years). Seventeen patients had stenotic lesions, and all had coronary aneurysms. MSCT was performed using a Siemens SOMATOM Volume Zoom (4-detector row) or a Toshiba Aquillion 16 (16-detector row). The detection of coronary calcification, stenotic lesion, and intimal hypertrophy was applied to all coronary arteries in MSCT and compared to CAG. Results Of the 18 patients, there were 11 (61%) in whom novel findings were detected by MSCT. Coronary calcifications were found in 11 of the 18 patients (61%) by MSCT. Five patients had concentric calcified aneurysms, 4 had eccentric calcified aneurysms, and the other 2 had mixed calcified aneurysms. Coronary stenotic lesions were present in 6 of the 18 patients (33%) with calcified aneurysms. There were 2 patients who had intimal hypertrophy (11%). One patient had intimal hypertrophy along the left main trunk with a giant calcified aneurysm along the left anterior descending artery. Two patients had severe stenoses just distal to giant calcified aneurysms that were regarded as false positive findings, which were identified as mild stenoses by CAG. Conclusions MSCT offers advantages over CAG in the evaluation of calcified aneurysms and intimal hypertrophy, and has the potential to become a diagnostic modality for coronary intervention in adolescents after Kawasaki disease.

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