Vessel Shrinkage as a Sign of Atherosclerosis Progression in Type 2 Diabetes Mellitus: A Serial Intravascular Ultrasound Analysis
- Pilar Jiménez-Quevedo, MD1,
- Nobuaki Suzuki, MD1,
- Cecilia Corros, MD, Ma1,
- Cruz Ferrer, MD1,
- Dominick J. Angiolillo, MD, PhD, FACC, FESC1,
- Fernando Alfonso, MD, PhD, FESC1,
- Rosana Hernández-Antolín, MD, PhD, FESC1,
- Camino Bañuelos, MD1,
- Javier Escaned, MD, PhD, FESC1,
- Cristina Fernández, MD, PhD1,
- Marco Costa, MD, PhD, FACC, FSCAI1,
- Carlos Macaya, MD, PhD, FESC1,
- Theodore Bass, MD, FACC1 and
- Manel Sabaté, MD, PhD, FESC (manelsabate1{at}telefonica.net)1
- 1From the Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain (P. JQ, M.S., F.A., R.H-A, C.B., J.E., R.M., C.M.); From the Research Unit, San Carlos, University Hospital, Madrid, Spain (C.F); From the University of Florida, Jacksonville, Florida, US (N.S, D.J.A., T.B, M.C.)
Abstract
Objective: The aim of this study was to determine the natural history of vascular remodeling of atherosclerotic plaques in patients with type 2 diabetes mellitus and the predictors of vessel shrinkage (VS).
Research Design and Methods: 235 coronary segments from 45 patients enrolled in the DIABETES I, II and III trials were included in this serial IVUS study. Quantitative volumetric IVUS analyses (motorized pullbacks at 0.5 mm/sec) were performed in the same coronary segment after the index procedure and at 9-month follow-up. Non-treated mild lesions (angiographic stenosis <25%) with >/=0.5mm plaque thickening and 5 >/=mm of length assessed by IVUS were included. VS was defined as a Δ EEM area/Δ plaque area <0. Statistical adjustment by multiple segments and multiple lesions per patient was performed.
Results: VS was identified in 36.7% of segments and was associated with a significant decrease in lumen area at 9-months (VS: 10±4mm2 vs. non-VS: 11±4; p=0.04). Independent predictors of VS were: insulin requirements (OR: 4.6; 95% CI.1.4015.10;p=0.01); glycated haemoglobin (OR:1.5; 95% CI.1.05-2.10;p=0.02); apolipoprotein B (OR:0.96; 95% CI.0.94-0.98;p<0.001); hypertension (OR:3.7; 95% CI.1.40-10.30;p=0.009); number of diseased vessels (OR:5.6; 95% CI.2.5012.50;p<0.001) and prior revascularization (OR:17.5; 95% CI.6.50-46.90;p<0.001).
Conclusions: This serial IVUS study suggests that progression of coronary artery disease in patients with type II diabetes mellitus may be mainly attributed to VS. Besides, VS is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis.
Footnotes
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- Received March 17, 2008.
- Accepted September 14, 2008.
- Copyright © American Diabetes Association
