MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy.

Marano, Riccardo; Pitocco, Dario; Stasio, Enrico; Savino, Giancarlo; Merlino, Biagio; Trani, Carlo; Pirro, Federica; Rutigliano, Claudia; Santangelo, Carolina; Minoiu, Aurelian; Natale, Luigi; Bonomo, Lorenzo; Di Stasio, Enrico; Minoiu, Aurelian Costin

<bold>Objectives: </bold>To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN).<bold>Methods: </bold>Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment.<bold>Results: </bold>CN patients showed higher rates of significant CAD in comparison with DN subjects [p < 0.001], while non-significant differences were observed in CACS (p = 0.980). No significant differences were also observed in CACS distribution in all subjects for stenosis ≥/<50 % (p = 0.814), as well as in both groups (p = 0.661 and 0.559, respectively). The MDCT-CA showed an overall diagnostic-accuracy for significant CAD of 87%.<bold>Conclusions: </bold>These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy.<bold>Key Points: </bold>Type 2-diabetic-patients with CN result having more severe coronary artery plaque-burden. MDCT-CA may stratify the CV risk in type 2-diabetic-patients with CN. Adequate diagnostic is mandatory for optimal management of type 2-diabetic-patients with CN.

TYPE 2 diabetes; DIABETES; DIABETIC neuropathies; PERIPHERAL neuropathy; CORONARY angiography; CORONARY heart disease complications; TYPE 2 diabetes complications; AMYOTROPHIC lateral sclerosis; CHARCOT joints; CORONARY disease; LONGITUDINAL method; SEVERITY of illness index; MULTIDETECTOR computed tomography; DISEASE complications

European Radiology, 2016, Vol 26, Issue 3, p788

0938-7994

Academic Journal

10.1007/s00330-015-3864-3