scholarly journals Prognostic irrelevance of plaque vulnerability following plaque sealing in high-risk patients with type 2 diabetes: an optical coherence tomography study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Rosalia Dettori ◽  
Andrea Milzi ◽  
Kathrin Burgmaier ◽  
Mohammad Almalla ◽  
Martin Hellmich ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Optical Coherence Tomography ◽  
High Risk ◽  
Clinical Parameters ◽  
Optical Coherence ◽  
Plaque Vulnerability ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background Type 2 diabetes mellitus (T2DM) is associated with an increased cardiovascular risk related at least in part to a more vulnerable plaque phenotype. However, patients with T2DM exhibit also an increased risk following percutaneous coronary intervention (PCI). It is unknown if plaque vulnerability of a treated lesion influences cardiovascular outcomes in patients with T2DM. In this study, we aimed to assess the association of plaque morphology as determined by optical coherence tomography (OCT) with cardiovascular outcome following PCI in high-risk patients with T2DM. Methods 81 patients with T2DM and OCT-guided PCI were recruited. Pre-interventional OCT and systematic follow-up of median 66.0 (IQR = 8.0) months were performed. Results During follow-up, 24 patients (29.6%) died. The clinical parameters age (HR 1.16 per year, 95% CI 1.07–1.26, p < 0.001), diabetic polyneuropathy (HR 3.58, 95% CI 1.44–8.93, p = 0.006) and insulin therapy (HR 3.25, 95% CI 1.21–8.70, p = 0.019) predicted mortality in T2DM patients independently. Among OCT parameters only calcium-volume-index (HR 1.71 per 1000°*mm, 95% CI 1.21–2.41, p = 0.002) and lesion length (HR 1.93 per 10 mm, 95% CI 1.02–3.67, p = 0.044) as parameters describing atherosclerosis extent were significant independent predictors of mortality. However, classical features of plaque vulnerability, such as thickness of the fibrous cap, the extent of the necrotic lipid core and the presence of macrophages had no significant predictive value (all p = ns). Conclusion Clinical parameters including those describing diabetes severity as well as OCT-parameters characterizing atherosclerotic extent but not classical features of plaque vulnerability predict mortality in T2DM patients following PCI. These data suggest that PCI may provide effective plaque sealing resulting in limited importance of local target lesion vulnerability for future cardiovascular events in high-risk patients with T2DM.

Identification of a spliceosome-associated fingerprint with potential to predict development of type 2 diabetes in high-risk patients

2016 ◽  
Author(s):  
Raul M. Luque ◽  
Manuel D. Gahete ◽  
Mercedes del Rio-Moreno ◽  
Sergio Pedraza-Arevalo ◽  
Antonio Camargo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients

2-OR: Impact of N Terminal Pro B-Type Natriuretic Peptide and High Sensitivity Cardiac Troponin on the Prediction of Death and Cardiovascular Events in High-Risk Patients with Type 2 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 2-OR
Author(s):  
MARCUS V.B. MALACHIAS ◽  
PARDEEP JHUND ◽  
BRIAN CLAGGETT ◽  
MAGNUS O. WIJKMAN ◽  
RHONDA BENTLEY-LEWIS ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Natriuretic Peptide ◽  
Cardiac Troponin ◽  
Cardiovascular Events ◽  
High Sensitivity ◽  
High Risk Patients ◽  
Risk Patients

Safety and Tolerability of Pioglitazone in High-Risk Patients with Type 2 Diabetes

Drug Safety ◽  
2009 ◽  
Vol 32 (3) ◽  
pp. 187-202 ◽  
Author(s):  
John Dormandy ◽  
Mondira Bhattacharya ◽  
Anne-Ruth van Troostenburg de Bruyn
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Intrinsic calcification angle: a novel feature of the vulnerable coronary plaque in patients with type 2 diabetes: an optical coherence tomography study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Sebastian Reith ◽  
Andrea Milzi ◽  
Enrico Domenico Lemma ◽  
Rosalia Dettori ◽  
Kathrin Burgmaier ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Optical Coherence Tomography ◽  
Finite Elements ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Plaque Vulnerability ◽  
Finite Elements Analysis ◽  
Coronary Syndrome ◽  
Fibrous Cap

Abstract Background Coronary calcification is associated with high risk for cardiovascular events. However, its impact on plaque vulnerability is incompletely understood. In the present study we defined the intrinsic calcification angle (ICA) as the angle externally projected by a vascular calcification and analyzed its role as novel feature of coronary plaque vulnerability in patients with type 2 diabetes. Methods Optical coherence tomography was used to determine ICA in 219 calcifications from 56 patients with stable coronary artery disease (CAD) and 143 calcifications from 36 patients with acute coronary syndrome (ACS). We then used finite elements analysis to gain mechanistic insight into the effects of ICA. Results Minimal (139.8 ± 32.8° vs. 165.6 ± 21.6°, p < 0.001) and mean ICA (164.1 ± 14.3° vs. 176.0 ± 8.4°, p < 0.001) were lower in ACS vs. stable CAD patients. Mean ICA predicted ACS with very good diagnostic efficiency (AUC = 0.840, 95% CI 0.797–0.882, p < 0.001, optimal cut-off 175.9°); younger age (OR 0.95 per year, 95% CI 0.92–0.98, p = 0.002), male sex (OR 2.18, 95% CI 1.41–3.38, p < 0.001), lower HDL-cholesterol (OR 0.82 per 10 mg/dl, 95% CI 0.68–0.98, p = 0.029) and ACS (OR 14.71, 95% CI 8.47–25.64, p < 0.001) were determinants of ICA < 175.9°. A lower ICA predicted ACS (OR for 10°-variation 0.25, 95% CI 0.13–0.52, p < 0.001) independently from fibrous cap thickness, presence of macrophages or extension of lipid core. In finite elements analysis we confirmed that lower ICA causes increased stress on a lesion’s fibrous cap; this effect was potentiated in more superficial calcifications and adds to the destabilizing role of smaller calcifications. Conclusion Our clinical and mechanistic data for the first time identify ICA as a novel feature of coronary plaque vulnerability.

Sign in / Sign up

Export Citation Format

Share Document