Importance of multidector computed tomography coronary angiography in evaluating ischemic heart disease in patients with type 1 Diabetes mellitus

[G. Milić]

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Medicina - Endokrinologija / Medicine - Endocrinology

Dijabetes melitus je jedan od ĉetiri glavna faktora rizika za nastanak ateroskleroze i ishemijske bolesti srca. Cilj naše studije je bio da ispitamo da li je multidetektorska kompjuterizovana tomografija koronarnih krvnih sudova (MDCTA) dobra metoda za rano otkrivanje ateroskleroze koronarnih arterija u pacijenata obolelih od dijabetes melitusa tip 1 (DMT1). Metod. Istraţivanje je raĊeno kao studija preseka na uzorku od 80 pacijenata obolelih od DMT1. Pacijenti su svrstani u grupu bez i grupu sa umerenom stenozom koronarne arterije. Svim pacijentima smo ispitivali faktore rizika za aterosklerozu (HbA1c, plazma koncentraciju homocisteina i serumsku koncentraciju 25(OH) vitamina D).Ultrazvukom smo merili debljinu intimomedijalnog kompleksa (IMK) karotidnih arterija dok smo MDCT koronarografijom detektovali stenoze koronarnih arterija. Rezultati. Neopstruktivne umerene stenoze koronarnih arterija smo dijagnostikovali kod 28(38,36%) pacijenata. Pacijenti sa umerenom stenozom koronarne arterije su imali znaĉajno viši nivo HbA1c(p<0,001), povišenu koncentraciju homocisteina (p<0,0019), povećanu debljinu IMK karotidnih arterija (p<0,001) i sniţenu serumsku koncentraciju 25(OH)vitamina D p<0,001) u poreĊenju sa pacijentima bez detektovane stenoze koronarne arterije. ROC analizom smo pokazali da su homocistein (AUCHcy=0,955; p<0,001), 25 (OH) vitamin D (AUCvitD=0,792;p<0,01) i debljina IMK karotidnih arterija (AUCCIMT=0,743;p<0,01) senzitivni i specifiĉni markeri za detekciju umerene stenoze koronarne arterije. Multivarijantnom regresionom analizom smo pokazali da je homocistein jedini pouzdan prediktor umerene stenoze koronarne arterije u pacijenata obolelih od DMT1.Zakljuĉak: MDCT koronarografija je dobra metoda za detekciju ateroskleroze koronarnih arterija u pacijenata obolelih od DMT1.

Introduction.Diabetes mellitus is one of the four main risk factors for the occurrence of atherosclerosis and ischemic heart disease. The aim was to investigate whether multidector computed tomography coronary angiography (MDCTA) is a good method for the early detection of coronary artery atherosclerosis in patients with type 1 diabetes mellitus (T1DM). Method. It was a cross-sectional study involving 80 patients with type 1 diabetes mellitus. The patients were divided into group with and without non-obstructive moderate coronary artery stenosis. All patients were subjected to the assessment of risk factors for atherosclerosis (HbA1c, plasma total concentration of homocysteine (tHcy), serum 25-hydroxy vitamin D (25(OH)D) concentration). Intima media thickness (IMT) of the carotid arteries was measured by ultrasound, while coronary artery stenosis was examined using MDCTA. Results.28 patients (38,36%) were diagnosed with moderate non-obstructive stenosis.The patients with moderate stenosis had significantly higher HbA1c(p<0,001), elevated tHcy (p<0,0019), increased CIMTmax (p<0,001) but lower 25(OH)D p<0,001) in comparison to patients without detectable coronary atherosclerosis. Homocysteine (AUCHcy=0,955; p<0,001),vitamin D (AUCvitD=0,792;p<0,01) and CIMT max(AUCCIMT=0,743;p<0,01) appear to be adequate markers for detecting stenosis of coronary arteries using receiver operating characteristic (ROC) curve analysis. Multivariate logistic regression analysis showed that serum homocysteine was the only significant predictor of moderate coronary artery stenosis in patients with T1DM.Conclusion. MDCT coronary angiography is a good method of detection coronary artery atherosclerosis in T1DM.

Dijabetes melitus tip 1, ateroskleroza, multidetektorska kompjuterizovana tomografija koronarnh krvnih sudova

Type 1 diabetes mellitus, atherosclerosis, multidector computed tomography coronary angiography

616.379-008.64:616.1-07(043.3)

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