GENDER DIFFERENCES AND PREDICTORS OF INCRASED CORONARY CALCIUM SCORE AND MYOCARDIAL ISCHEMIA IN DIABETES TYPE 2 PATIENTS

  • Irena Mitevska University Cardiology Clinic, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. of North Macedonia
  • Maja Zdravkovska Institute for Pathophysiology and Nuclear Medicine, Faculty of Medicine,Ss. Cyril and Methodius University in Skopje, R. of North Macedonia
  • Bojana Stoilovska Institute for Pathophysiology and Nuclear Medicine, Faculty of Medicine,Ss. Cyril and Methodius University in Skopje, R. of North Macedonia
  • Nevena Manevska Institute for Pathophysiology and Nuclear Medicine, Faculty of Medicine,Ss. Cyril and Methodius University in Skopje, R. of North Macedonia
  • Magdalena Mileva Institute for Pathophysiology and Nuclear Medicine, Faculty of Medicine,Ss. Cyril and Methodius University in Skopje, R. of North Macedonia
  • Marija Vavlukis University Cardiology Clinic, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. of North Macedonia

Abstract

We wanted to assess prevalence, predictors and gender difference of coronary calcium score (CCS) and myocardial ischemia in diabetes type 2 patients.  We have evaluated 145 patients (58 male and 87 females, age 63+/-9), who underwent single-photon emission computed tomography myocardial perfusion imaging computer tomography (SPECT/CT) for assessment of myocardial ischemia and coronary atherosclerosis burden. Forward logistic regression analysis was used to assess predictive parameters for myocardial ischemia and increased CAC. Gender differences between myocardial perfusion and CCS findings were analyzed. SPECT results were normal in 102 patients (70%). Mild ischemia was noted in 16 patients (37%), moderate ischemia in 9 patients (20%), severe ischemia in 10 patients (23%), and fixed defects in 8 patients (18%). CCS >0 Agatston Units (AU) was found in 69 patients (62.7%), with average CAC 198+/-45 in male and 98+/33AU in female patients. 24 patients (34%) had moderate CCS (100–399 AU) and 19 patients (27.5%) had severe CCS (401–1000 AU). Multivariate regression analysis showed independent predictors for CCS (>0AU) age (⩾65 years) (odds ratio (OR): 1.074, p = 0.028), smoking (OR: 1.81, p = 0.048) and male gender (OR: 1.43, p = 0.051). We found stress-induced ECG changes, CCS>400AU and diabetes type 2 over 10 years to be independent predictors of myocardial ischemia in the model that included CCS. CCS was increased predominantly in male and myocardial ischemia was more prevalent in female patients. SPECT/CT imaging enable assessment of anatomic and functional aspects of CAD and optimize treatment in diabetes type 2 patients.


Keywords:Myocardial perfusion imaging, coronary calcium score, type 2 diabetes, coronary artery disease

References

1. Cosentino F, Grant PJ, Aboyans V et al. ESC Scientific Document Group. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020 Jan 7;41(2):255-323.
2. Mach F, Baigent C, Catapano AL et al. ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1;41(1):111-188.
3. Sarwar N, Gao P, Seshasai SR, et al. Emerging Risk Factors Collaboration Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010;375:2215–2222
4. Nakao YM, Miyamoto Y, Higashi M et al. Sex differences in impact of coronary artery calcification to predict coronary artery disease. Heart. 2018 Jul;104(13):1118-1124.
5. Wackers FJ, Young LH, Inzucchi SE et al. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Detection of Ischemia in Asymptomatic Diabetics Investigators. Diabetes Care. 2004 Aug;27(8):1954-61.
6. ISCHEMIA Trial Research Group, Maron DJ, Hochman JS, O'Brien SM et al. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial: Rationale and design. Am Heart J. 2018 Jul;201:124-135.
7. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc Diabetol. 2018;17(1):83
8. Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–234.
9. Schurgin S, Rich S, Mazzone T. Increased prevalence of significant coronary artery calcification in patients with diabetes. Diabetes Care 2001;24:335–338
10. Pencina MJ, D'Agostino RB Sr, D'Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 2008;27:157–172
11. Godsland IF, Elkeles RS, Feher MD et al. PREDICT Study Group. Coronary calcification, homocysteine, C-reactive protein and the metabolic syndrome in Type 2 diabetes: the Prospective Evaluation of Diabetic Ischaemic Heart Disease by Coronary Tomography (PREDICT) Study. Diabet Med. 2006 Nov;23(11):1192-200.
12. Erbel R, Möhlenkamp S, Moebus S, et al. Heinz Nixdorf Recall Study Investigative Group Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 2010;56:1397–1406
13. Regitz-Zagrosek V, Kararigas G. Mechanistic Pathways of Sex Differences in Cardiovascular Disease. Physiol Rev. 2017 Jan;97(1):1-37.
14. The EUGenMed, Cardiovascular Clinical Study Group, Vera Regitz-Zagrosek, Sabine Oertelt-Prigione, Eva Prescott et al. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. European Heart Journal, Volume 37, Issue 1, 1 January 2016, Pages 24–34
15. Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) Circulation. 2007;115:402–426.
16. Folsom AR, Kronmal RA, Detrano RC, et al. Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med 2008;168:1333–1339
17. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–1345.
18. Schaap J, Kauling RM, Boekholdt SM, et al. Usefulness of coronary calcium scoring to myocardial perfusion SPECT in the diagnosis of coronary artery disease in a predominantly high risk population. Int J Cardiovasc Imaging. doi: 10.1007/s10554-012-0118-1
19. Arabi AR, Alqahtani A, Alsuwaidi J. After Ischemia Trial, What is the Role of Ischemia Detection on Noninvasive Testing?. Heart Views. 2020;21(1):31.
20. Rosman J, Shapiro M, Pandey A, VanTosh A, Bergmann SR. Lack of correlation between coronary artery calcium and myocardial perfusion imaging. J Nucl Cardiol. 2006;13:333–337.
21. Almoudi M, Sun ZH. A head-to-head comparison of the coronary calcium score by computed tomography with myocardial perfusion imaging in predicting coronary artery disease. J Geriatr Cardiol. 2012;9(4):349‐354.
22. Greenland P, Labree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291:210–215
Published
2021-03-16
How to Cite
MITEVSKA, Irena et al. GENDER DIFFERENCES AND PREDICTORS OF INCRASED CORONARY CALCIUM SCORE AND MYOCARDIAL ISCHEMIA IN DIABETES TYPE 2 PATIENTS. Journal of Morphological Sciences, [S.l.], v. 4, n. 1, p. 83-94, mar. 2021. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/190>. Date accessed: 19 may 2021.
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Articles