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Open Access Original investigation

Plaque vulnerability of coronary artery lesions is related to left ventricular dilatation as determined by optical coherence tomography and cardiac magnetic resonance imaging in patients with type 2 diabetes

Mathias Burgmaier1, Michael Frick1, Ana Liberman1, Simone Battermann1, Martin Hellmich2, Walter Lehmacher2, Agnes Jaskolka3, Nikolaus Marx1 and Sebastian Reith1*

Author Affiliations

1 Department of Internal Medicine I, University Hospital of the RWTH Aachen, Aachen, Germany

2 Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany

3 Interdisciplinary Center of Clinical Research (IZKF), University Hospital of the RWTH Aachen, Aachen, Germany

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Cardiovascular Diabetology 2013, 12:102  doi:10.1186/1475-2840-12-102

Published: 11 July 2013

Abstract

Background

Patients with type 2 diabetes are at increased risk for both, left ventricular (LV)-dilatation and myocardial infarction (MI) following the rupture of a vulnerable plaque. This study investigated the to date incompletely understood relationship between plaque vulnerability and LV-dilatation using optical coherence tomography (OCT) and cardiac magnetic resonance imaging (CMR) in patients with type 2 diabetes and stable coronary artery disease.

Methods

CMR was performed in 58 patients with type 2 diabetes, in which 81 coronary lesions were investigated using OCT.

Results

A decreased minimal fibrous cap thickness (FCT) of coronary lesions was associated with an increase of several CMR-derived parameters including LV-end diastolic volume (LVEDV, r = 0.521, p < 0.001), LV-end diastolic diameter (r = 0.502, p < 0.001) and LV-end systolic volume (r = 0.467, p = 0.001). Similar results were obtained for mean FCT.

Furthermore, patients with dilated versus non-dilated LV differed significantly in several cardiovascular risk factors including previous MI (47.1% vs. 14.6%, p = 0.009), HDL-cholesterol (40.35 ± 5.57 mg/dl vs. 45.20 ± 10.79 mg/dl, p = 0.029) and smoking (82.4% vs. 51.2%, p = 0.027). However, minimal FCT is associated to LV-dilatation independent of previous MIs (odds ratio 0.679, p = 0.022).

Receiver-operating curve analysis demonstrated that CMR-derived LVEDV predicts plaque vulnerability with low-moderate diagnostic efficiency (area under the curve 0.699) and considerate specificity (83.3%) at the optimal cut-off value (159.0 ml).

Conclusion

These data suggest that vulnerability of coronary lesions is associated with LV-dilatation in high risk patients with type 2 diabetes. CMR may be a useful adjunct to the risk-stratification in this population. Future studies are warranted to investigate potential mechanisms linking plaque vulnerability and LV-dilatation.

Keywords:
Type 2 diabetes mellitus; Cardiac magnetic resonance imaging; Optical coherence tomography; Minimal fibrous cap thickness; Coronary plaque morphology