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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



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.


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


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).


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.

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