Author + information
- Received October 9, 2017
- Revision received April 11, 2018
- Accepted April 12, 2018
- Published online October 1, 2018.
- Ung Kim, MD, PhDa,b,
- Jonathon A. Leipsic, MDa,c,∗ (, )
- Stephanie L. Sellers, PhDa,c,
- Michael Shao, BSca,
- Philipp Blanke, MD, PhDa,
- Martin Hadamitzky, MDd,
- Yong-Jin Kim, MD, PhDd,e,
- Edoardo Conte, MDf,
- Daniele Andreini, MD, PhDf,
- Gianluca Pontone, MD, PhDf,
- Matthew J. Budoff, MDg,
- Ilan Gottlieb, MD, PhDh,
- Byoung Kwon Lee, MD, PhDi,
- Eun Ju Chun, MD, PhDj,
- Filippo Cademartiri, MD, PhDk,
- Erica Maffei, MDl,
- Hugo Marques, MDm,
- Sanghoon Shin, MDn,
- Jung Hyun Choi, MD, PhDo,
- Renu Virmani, MDp,
- Habib Samady, MDq,
- Peter H. Stone, MDr,
- Daniel S. Berman, MDs,
- Jagat Narula, MD, PhDt,
- Leslee J. Shaw, PhDu,
- Jeroen J. Bax, MD, PhDv,
- James K. Min, MDw and
- Hyuk-Jae Chang, MD, PhDx
- aDepartment of Radiology, St. Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- bYeungnam University Medical Center, Daegu, South Korea
- cCentre for Heart Lung Innovation, University of British Columbia and St. Paul’s Hospital, Vancouver, British Columbia, Canada
- dDepartment of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
- eSeoul National University Hospital, Seoul, South Korea
- fCentro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- gDepartment of Medicine, Harbor UCLA Medical Center, Los Angeles, California
- hDepartment of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
- iGangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- jSeoul National University Bundang Hospital, South Korea
- kCardiovascular Imaging Center, SDN Foundation IRCCS, Naples, Italy
- lDepartment of Radiology, Area Vasta 1/Azienda Sanitaria Unica Regionale (ASUR) Marche, Urbino, Italy
- mHospital da Luz, Lisbon, Portugal
- nNational Health Insurance Service Ilsan Hospital, Goyang, South Korea
- oBusan University Hospital, Busan, South Korea
- pDepartment of Pathology, CVPath Institute, Gaithersburg, Maryland
- qDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- rCardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- sDepartment of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, California
- tIcahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, New York
- uDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- vDepartment of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
- wDalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York
- xDivision of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Seoul, South Korea
- ↵∗Address for correspondence:
Dr. Jonathon A. Leipsic, Department of Radiology, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
Objectives This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM).
Background The natural history of coronary PP in patients with DM is not well established.
Methods A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0.
Results DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (−7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM.
Conclusions People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.
This study was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (grant No. 2012027176) and funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr. Leipsic has served as a consultant to and holds stock options in Circle Cardiovascular Imaging and HeartFlow; and has received speaking fees from GE Healthcare. Dr. Blanke has received funds from Edwards Lifesciences, Tendyne, Neovasc, and Circle Cardiovascular Imaging. Dr. Andreini has served on the Speakers Bureau for GE Healthcare; and has received grant support from GE Healthcare and Bracco. Dr. Pontone has received institutional research grants from GE Healthcare, HeartFlow, Medtronic, Bracco, and Bayer. Dr. Budoff has received grant support from the National Institutes of Health and GE Healthcare. Dr. Chun has received a National Research Foundation grant funded by the Korean government (Ministry of Education, Science and Technology; NRF-2015R1D1A1A01059717). Dr. Virmani has received institutional research support from 480 Biomedical, Abbott Vascular, ART, BioSensors International, Biotronik, Boston Scientific, Celonova, Claret Medical, Cook Medical, Cordis, Edwards Lifesciences, Medtronic, MicroVention, OrbusNeich, ReCor Medical, SINO Medical Technology, Spectranetics, Surmodics, Terumo Corporation, W.L. Gore, and Xeltis; has received honoraria from 480 Biomedical, Abbott Vascular, Boston Scientific, Cook Medical, Lutonix, Medtronic, Terumo Corporation, and W.L. Gore; and is a consultant for 480 Biomedical, Abbott Vascular, Medtronic, and W.L. Gore. Dr. Samady has received grant support from Phillips/Volcano, St. Jude, Abbott, Medtronic, and Gilead. Dr. Berman has received software royalties from Cedars-Sinai. Dr. Bax has received unrestricted research grants from Biotronik, Medtronic, Boston Scientific, and Edwards Lifesciences. Dr. Min has received funding from the National Institutes of Health (grant Nos. R01 HL111141, R01 HL115150, R01 118019, and U01 HL 105907), the Qatar National Priorities Research Program (grant No. 09-370-3-089), and GE Healthcare; has served as a consultant to HeartFlow; serves on the scientific advisory board of Arineta; and has an equity interest in MDDX. Dr. Chang has received funding from the Leading Foreign Research Institute Recruitment Program through the NRF of Korea funded by the Ministry of Science, ICT and Future Planning (grant No. 2012027176). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Todd Villines, MD, served as the Guest Editor for this paper.
- Received October 9, 2017.
- Revision received April 11, 2018.
- Accepted April 12, 2018.
- 2018 American College of Cardiology Foundation
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