الفهرس 
Cardiac CTOnly 14 pages are availabe for public view
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Abstract
Patients are usually diagnosed with CAD when they develop symptoms, display an abnormal response to stress testing or undergo coronary angiographies. Unfortunately, by that time, the atherosclerotic process is relatively advanced and many patients already have had myocardial infarction or have activity-limiting angina. In many ways, the opportunity for prevention may have been missed or, in retrospect, delayed, in these patients.
Therefore, early detection of CAD could impact this scenario significantly by accelerating prevention efforts and positively impacting patient lifestyle choices, before the development of clinical manifestations of heart disease.
The aim of the study was to find out the relationship between calcium scoring and coronary atherosclerosis with assessment of influence of diabetes on extent of atherosclerosis as detected by 64 multislice CT angiography.
The study included 60 ischemic patients divided into two groups, group I include 30 ischemic diabetic patients at the age 40 – 66 referred for MSCT for diagnosis of coronary artery disease. Group II include another 30 ischemic non-diabetic age and sex matched patients referred for diagnostic MSCT as a control group.
Patients with AF or irregular rhythm, tachyarrhythmia, Severe congestive heart failure, chronic Obstructive pulmonary disease (COPD), heart Block, hemodynamic instability, allergy to contrast material, unable to hold breath, any concomitant valvular or congenital heart disease,terminal renal or hepatic impairment were excluded from the study.
All patients included in the study were subjected to full history taking with special emphasis of history of Diabetes Mellitus, drug therapy,complications of diabetes and cardiac history, full general and local, examination of the heart, chest and abdomen, 12 leads resting ECG, laboratory investigations including: Fasting and 2 hours post-prandial blood sugar level,blood urea, serum creatinine, SGPT, SGOT, PT, Cholesterol, Triglycerides, HDL, LDL, uric acid and urine analysis for microabumenuria, M-mode, 2 Dimensional and echo Doppler study and Multislice CT examination using a 64-section CT scanner (Toshiba Aquilion 64). ECG gated scan without the use of contrast was done from the aortic bulb to the tip of the heart with a 64-section CT scanner (Toshiba Aquilion 64) at a single breath-hold,Images were collected and processed via Vitrea® software to assess calcium in all coronary vessels and to calculate calcium score by agataston score system, after calcium score assessment, those with calcium score >1000 were excluded from the study.
The rest of patients were scanned using contrast enhanced Helical MSCT 64-slices coronary angiography was performed following IV administration of 80 ml of non-ionic contrast iodixanol (Visipaque 320). ECG gated acquisition at a single breath-hold with reconstruction of cardiac chambers and coronary vessels. All coronary segments were studied at 75% and 40% of cardiac cycle, with selective reconstruction of the improperly visualized coronary segments at different phases of cardiac cycle. Axial images, multi-planar coronal, sagittal and curved MPR images were collected and processed to assess all coronary segments (course, patency and luminal study).
Descriptive statistics were done including mean, standard deviation and prevalence, Chi-square test was done to find out the presence of significant difference between the two groups regarding the non-parametric variables. Paired student’s t-test was done to find out the presence of significant difference between the two groups regarding the parametric variables. P < 0.05 will be considered significant with a confidence interval of 95%.
Results of the current study showed that the calcium score was significantly higher among patients with type 2 diabetes Mellitus than the controls (276.1 ± 819.7 for diabetic patients vs 103.4 ± 218.7 for the non-diabetic patients) (P < 0.001).
Results also showed that the mean number of diseased segments was significantly higher among the studied patients than that of the controls (P < 0.001). Also the percentage of obstructive lesion was significantly higher among the studied patients than that of the controls (P < 0.001).
Results showed that the calcium score was significantly higher among diabetic patients with obstructive lesion in comparison to the diabetic with non obstructive lesions (879 ± 563 for the obstructive lesion vs 121.6 ± 235.8 for the non obstrutive lesion) (p < 0.00).