Open Access
Usefulness of carotid plaque (sum and maximum of plaque thickness) in combination with intima‐media thickness for the detection of coronary artery disease in asymptomatic patients with diabetes
Author(s) -
Akazawa Shoichi,
Tojikubo Masayuki,
Nakano Yuko,
Nakamura Satoe,
Tamai Hidekazu,
Yonemoto Koji,
Sadasima Eiji,
Kawasaki Tomohiro,
Koga Nobuhiko
Publication year - 2016
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.12403
Subject(s) - medicine , coronary artery disease , asymptomatic , intima media thickness , cardiology , diabetes mellitus , type 2 diabetes , area under the curve , common carotid artery , carotid arteries , logistic regression , nuclear medicine , endocrinology
Abstract Aims/Introduction The usefulness of markers of carotid plaque, such as sum ( PS ) and maximum (P‐max) of the plaque thickness, in combination with intima‐media thickness in the common carotid artery ( CIMT ) for the detection of obstructive coronary artery disease ( CAD ) was investigated in patients with type 2 diabetes without known CAD . Materials and Methods B‐mode ultrasonographic scanning of the carotid artery and multislice computed tomography coronary angiography were carried out in 332 asymptomatic patients with type 2 diabetes. Results For the presence of obstructive CAD when incorporating PS or P‐max to standard risk factors in a multiple logistic regression model, the classification ability in PS and P‐max increased greatly (area under the curve [ AUC ] 0.827 vs 0.720 [net reclassification index { NRI } = 0.652, P < 0.01] and AUC 0.820 vs 0.720 [ NRI = 0.775, P < 0.01], respectively), and it in CIMT increased slightly ( AUC 0.740 vs 0.720, NRI = 0.230, P = 0.041). Furthermore, the classification abilities for a model with interaction terms between PS * or P‐max* and CIMT were statistically larger than those for a model without interaction terms ( AUC 0.833 vs 0.827 [ NRI = 0.411, P < 0.01] and 0.823 vs 0.820 [ NRI = 0.269, P < 0.05], respectively). Partitioning showed the patients in the values of the PS <2.6 mm and CIMT <0.725 mm (100%), or in P‐max <2.1 mm and CIMT <0.725 mm (95.4%), did not have obstructive CAD , whereas those in the values of PS ≧ 2.6 mm, presence of hyperlipidemia and CIMT ≧ 0.675 mm (84%) or those in the value of P‐max ≧ 2.1 mm and body mass index ≧ 24 (91.7%) had obstructive CAD . Conclusions Although the P‐max and PS in the carotid artery were useful as detectors of CAD , combining them with CIMT provided a much superior first‐line screening method in detecting CAD in asymptomatic patients with diabetes.