Coronary Artery Disease Features and Epicardial Adipose on CT are Predictive Factors for Cardiovascular Events in Type 2 Diabetic Patients at High/Very High Cardiovascular Risk: A Pilot Retrospective Study

Aim: The study aimed to estimate the association between characterizations on coronary computed tomography angiography (CCTA) and cardiovascular events in type 2 diabetic patients at high/very high cardiovascular risk without known coronary artery disease (CAD), to investigate the incremental value of CCTA in these individuals. Methods: 82 type 2 diabetes patients without known CAD were enrolled according to the 2019 European Society of Cardiology (ESC) guidelines of high/ very high cardiovascular risk. The coronary artery calcium score, plaque location and extent and composition, stenosis severity, and epicardial adipose tissue (EAT) volume were evaluated. The cardiovascular events included cardiac death, non-fatal myocardial infarction, coronary revascularization, non-fatal stroke, hospitalization for unstable angina, and hospitalization for congestive heart failure during a mean follow-up period of 4.7±1.5 years. Univariate analysis and multivariate regression were used to obtain independent risk factors for CVEVs in these patients. The increased discriminative value after the addition of CAD features and EATS volume to the established clinical risk factors were estimated using the area under a receiver-operating characteristic curve (AUC). Results: CVEVs occurred in 26.8% of the patients. Independent predictors of CVEVs included hypertension (odds ratio (OR) 3.844, P=0.020), diabetes duration (OR 1.129, P=0.049), creatinine (OR 1.072, P=0.022), ABOS (OR 1.729, P=0.031), SSS (OR 1.213, P=0.021), and EAT volume (OR 1.025, P=0.012) The combination of ABOS, SSS and clinical risk factors improved the identify of CVEVs, with an area under the receiver operating characteristic curve of 0.955 (95% confidence interval 0.885 to 0.989; P=0.004) for the prediction of the endpoints. Conclusion: The extent and severity of overall coronary atheroma burden and EAT volume based on CCTA are associated with long-term CVEVs for type 2 diabetic patients at high/very high cardiovascular risk. CCTA has incremental value in evaluating the heterogeneity of such subclinical patients and beneficial forewarning for these individuals with CVEVs.