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In patients with diabetes mellitus, myocardial perfusion defects are often observed in the absence of obstructive Coronary Artery Disease (CAD), thereby presenting a diagnostic problem. Meanwhile, the indications for Multidetector Computed Tomography (MDCT) in the early diagnosis of CAD in diabetic patients has not yet been clarified. We performed MDCT with written informed consent on 74 type 2 diabetic patients (57 men and 17 women, mean age 57.6 ± 10.4 years, mean body mass index 25.8 ± 4.9 Kg/m2, mean glycosylated hemoglobin (HbA1c) 7.2 ± 1.4 %, smokers 39.2%) with no symptoms or history of CAD. Blood pressure and low-density lipoprotein cholesterol were well controlled. Patients treated with insulin or those who had serum creatinine levels > 1.0 mg/dl were excluded, and all patients had a negative exercise tolerance stress test. Only 17 patients (23.0%) were found to have normal coronary arteries, with neither plaque nor calcification. Coronary plaques were found in 26 patients (35.1%), and calcification was found in 25 (33.8%). MDCT angiography also demonstrated significant (> 50%) stenosis in 21 of 74 cases (28.4%). Various clinical parameters were compared between patients with obstructive CAD who showed significant (> 50%) stenosis and non-obstructive CAD patients without significant stenosis. The obstructive CAD group had significantly greater age, and higher serum creatinine levels, brachial Pulse Wave Velocity (PWV), and carotid artery intima-media thickness evaluated by ultrasonography. HbA1c, waist circumference, visceral fat area, cholesterol, and blood pressure were not significantly different between the groups. In the multivariate analysis, PWV, plaque score, and serum creatinine were independent factors for estimating the presence of advanced coronary lesions.

Brachial-ankle Pulse Wave Velocity and Renal Function can Predict Coronary Artery Disease in Asymptomatic Japanese Patients with Type 2 Diabetes