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Original Research

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

Halon D.A.a-c · Ayman J.a · Rubinshtein R.a, c · Zafrir B.a · Azencot M.a · Lewis B.S.b, c

Author affiliations

aDepartment of Cardiovascular Medicine and bCardiovascular Clinical Trials Institute, Lady Davis Carmel Medical Center, and cRuth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

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Cardiology 2017;138:218-227

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Article / Publication Details

First-Page Preview
Abstract of Original Research

Received: June 26, 2017
Accepted: June 26, 2017
Published online: August 18, 2017
Issue release date: December 2017

Number of Print Pages: 10
Number of Figures: 2
Number of Tables: 4

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: https://www.karger.com/CRD

Abstract

Objectives: Predictive models for heart failure (HF) in heterogeneous populations have had limited success. We examined cardiac computed tomography angiography (CTA) predictors of HF or cardiovascular death (HF-CVD) in a prospective study of asymptomatic diabetics undergoing baseline assessment by CTA. Methods: The subjects (n = 735, aged 55-74 years, 51.2% women) had no clinical history of cardiovascular disease at study entry. Coronary artery calcium (CAC) score, CTA-defined coronary atherosclerosis, cardiac chamber volumes, and clinical data were collected and late outcome events recorded over 8.4 ± 0.6 years (range 7.3-9.3). Results: HF-CVD occurred in 41 (5.6%) subjects, with HF occurring mostly (19/23, 82.6%) in subjects without preceding myocardial infarction. Baseline univariate clinical outcome predictors of HF-CVD included older age (p = 0.027), the duration of diabetes (p = 0.004), HbA1c (p < 0.0001), microvascular disease (retinopathy, microalbuminuria) (p < 0.0001), and systolic blood pressure (p = 0.035). Baseline univariate CTA predictors included CAC score (p = 0.004), coronary stenosis (p = 0.047), and a CTA-defined left/right atrial (LA/RA) volume ratio >1 (p < 0.0001). Independent predictors were an LA/RA volume ratio >1, microvascular disease, and systolic blood pressure (model C-statistic 0.792, 95% CI 0.758-0.824). Measures of the extent of coronary artery disease (CAD) were not independent predictors of HF-CVD. Conclusions: In a low- to moderate-risk asymptomatic diabetic population, CTA LA enlargement (LA/RA volume ratio) but not the extent of CAD had independent prognostic value for HF-CVD in addition to the clinical variables.

© 2017 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Original Research

Received: June 26, 2017
Accepted: June 26, 2017
Published online: August 18, 2017
Issue release date: December 2017

Number of Print Pages: 10
Number of Figures: 2
Number of Tables: 4

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: https://www.karger.com/CRD


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