The Role of Coronary Computed Tomography Angiography in the Diagnosis, Risk Stratification, and Management of Patients with Diabetes and Chest Pain
Coronary artery disease (CAD) affects over 200 million individuals globally, accounting for approximately 9 million deaths annually. Patients living with diabetes mellitus exhibit an up to fourfold increased risk of developing CAD compared to individuals without diabetes. Furthermore, CAD is respons...
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IMR Press
2024-12-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/25/12/10.31083/j.rcm2512442 |
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| author | Willem R. van de Vijver Jasper Hennecken Ioannis Lagogiannis Candelas Pérez del Villar Cristian Herrera Philippe C Douek Amit Segev G. Kees Hovingh Ivana Išgum Michiel M. Winter R. Nils Planken Bimmer E.P.M. Claessen |
| author_facet | Willem R. van de Vijver Jasper Hennecken Ioannis Lagogiannis Candelas Pérez del Villar Cristian Herrera Philippe C Douek Amit Segev G. Kees Hovingh Ivana Išgum Michiel M. Winter R. Nils Planken Bimmer E.P.M. Claessen |
| author_sort | Willem R. van de Vijver |
| collection | DOAJ |
| description | Coronary artery disease (CAD) affects over 200 million individuals globally, accounting for approximately 9 million deaths annually. Patients living with diabetes mellitus exhibit an up to fourfold increased risk of developing CAD compared to individuals without diabetes. Furthermore, CAD is responsible for 40 to 80 percent of the observed mortality rates among patients with type 2 diabetes. Patients with diabetes typically present with non-specific clinical complaints in the setting of myocardial ischemia, and as such, it is critical to select appropriate diagnostic tests to identify those at risk for major adverse cardiac events (MACEs) and for determining optimal management strategies. Studies indicate that patients with diabetes often exhibit more advanced atherosclerosis, a higher calcified plaque burden, and smaller epicardial vessels. The diagnostic performance of coronary computed tomographic angiography (CCTA) in identifying significant stenosis is well-established, and as such, CCTA has been incorporated into current clinical guidelines. However, the predictive accuracy of obstructive CAD in patients with diabetes has been less extensively characterized. CCTA provides detailed insights into coronary anatomy, plaque burden, epicardial vessel stenosis, high-risk plaque features, and other features associated with a higher incidence of MACEs. Recent evidence supports the efficacy of CCTA in diagnosing CAD and improving patient outcomes, leading to its recommendation as a primary diagnostic tool for stable angina and risk stratification. However, its specific benefits in patients with diabetes require further elucidation. This review examines several key aspects of the utility of CCTA in patients with diabetes: (i) the diagnostic accuracy of CCTA in detecting obstructive CAD, (ii) the effect of CCTA as a first-line test for individualized risk stratification for cardiovascular outcomes, (iii) its role in guiding therapeutic management, and (iv) future perspectives in risk stratification and the role of artificial intelligence. |
| format | Article |
| id | doaj-art-d2c43347763c426984e244db3f5cc4bf |
| institution | DOAJ |
| issn | 1530-6550 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj-art-d2c43347763c426984e244db3f5cc4bf2025-08-20T02:51:14ZengIMR PressReviews in Cardiovascular Medicine1530-65502024-12-01251244210.31083/j.rcm2512442S1530-6550(24)01613-2The Role of Coronary Computed Tomography Angiography in the Diagnosis, Risk Stratification, and Management of Patients with Diabetes and Chest PainWillem R. van de Vijver0Jasper Hennecken1Ioannis Lagogiannis2Candelas Pérez del Villar3Cristian Herrera4Philippe C Douek5Amit Segev6G. Kees Hovingh7Ivana Išgum8Michiel M. Winter9R. Nils Planken10Bimmer E.P.M. Claessen11Department of Cardiology, Heart Center, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Cardiology, Heart Center, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Cardiology, University Hospital of Salamanca, 37007 Salamanca, SpainDepartment of Cardiology, University Hospital of Salamanca, 37007 Salamanca, SpainUniversity of Lyon, INSA-Lyon, Claude Bernard Lyon 1 University, UJM-Saint Etienne, CNRS, Inserm, 69621 Villeurbanne, FranceDepartment of Cardiology, Leviev Heart Center, Chaim Sheba Medical Center, 52621 Tel Hashomer, IsraelDepartment of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Cardiology, Heart Center, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Cardiology, Heart Center, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsCoronary artery disease (CAD) affects over 200 million individuals globally, accounting for approximately 9 million deaths annually. Patients living with diabetes mellitus exhibit an up to fourfold increased risk of developing CAD compared to individuals without diabetes. Furthermore, CAD is responsible for 40 to 80 percent of the observed mortality rates among patients with type 2 diabetes. Patients with diabetes typically present with non-specific clinical complaints in the setting of myocardial ischemia, and as such, it is critical to select appropriate diagnostic tests to identify those at risk for major adverse cardiac events (MACEs) and for determining optimal management strategies. Studies indicate that patients with diabetes often exhibit more advanced atherosclerosis, a higher calcified plaque burden, and smaller epicardial vessels. The diagnostic performance of coronary computed tomographic angiography (CCTA) in identifying significant stenosis is well-established, and as such, CCTA has been incorporated into current clinical guidelines. However, the predictive accuracy of obstructive CAD in patients with diabetes has been less extensively characterized. CCTA provides detailed insights into coronary anatomy, plaque burden, epicardial vessel stenosis, high-risk plaque features, and other features associated with a higher incidence of MACEs. Recent evidence supports the efficacy of CCTA in diagnosing CAD and improving patient outcomes, leading to its recommendation as a primary diagnostic tool for stable angina and risk stratification. However, its specific benefits in patients with diabetes require further elucidation. This review examines several key aspects of the utility of CCTA in patients with diabetes: (i) the diagnostic accuracy of CCTA in detecting obstructive CAD, (ii) the effect of CCTA as a first-line test for individualized risk stratification for cardiovascular outcomes, (iii) its role in guiding therapeutic management, and (iv) future perspectives in risk stratification and the role of artificial intelligence.https://www.imrpress.com/journal/RCM/25/12/10.31083/j.rcm2512442coronary artery diseasecoronary computed tomography angiographydiabetes mellitus |
| spellingShingle | Willem R. van de Vijver Jasper Hennecken Ioannis Lagogiannis Candelas Pérez del Villar Cristian Herrera Philippe C Douek Amit Segev G. Kees Hovingh Ivana Išgum Michiel M. Winter R. Nils Planken Bimmer E.P.M. Claessen The Role of Coronary Computed Tomography Angiography in the Diagnosis, Risk Stratification, and Management of Patients with Diabetes and Chest Pain Reviews in Cardiovascular Medicine coronary artery disease coronary computed tomography angiography diabetes mellitus |
| title | The Role of Coronary Computed Tomography Angiography in the Diagnosis, Risk Stratification, and Management of Patients with Diabetes and Chest Pain |
| title_full | The Role of Coronary Computed Tomography Angiography in the Diagnosis, Risk Stratification, and Management of Patients with Diabetes and Chest Pain |
| title_fullStr | The Role of Coronary Computed Tomography Angiography in the Diagnosis, Risk Stratification, and Management of Patients with Diabetes and Chest Pain |
| title_full_unstemmed | The Role of Coronary Computed Tomography Angiography in the Diagnosis, Risk Stratification, and Management of Patients with Diabetes and Chest Pain |
| title_short | The Role of Coronary Computed Tomography Angiography in the Diagnosis, Risk Stratification, and Management of Patients with Diabetes and Chest Pain |
| title_sort | role of coronary computed tomography angiography in the diagnosis risk stratification and management of patients with diabetes and chest pain |
| topic | coronary artery disease coronary computed tomography angiography diabetes mellitus |
| url | https://www.imrpress.com/journal/RCM/25/12/10.31083/j.rcm2512442 |
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