Coronary atherosclerosis, myocardial perfusion, and interstitial fibrosis between diabetic and nondiabetic patients with stable chest pain: a propensity score matching study.

Objectives

To evaluate the effect of diabetes mellitus on coronary atherosclerosis, myocardial perfusion, and interstitial fibrosis using cardiac CT.

Methods

This study included 409 diabetic patients with stable chest pain who prospectively underwent coronary CT angiography (CCTA), stress CT myocardial perfusion imaging (CT-MPI), and late iodine enhancement (LIE). Additionally, 413 symptomatic non-diabetic patients were retrospectively enrolled as controls. Propensity score matching (1:1) was performed based on cardiovascular risk factors. Cardiac CT parameters including coronary artery calcium score, stenosis extent, high-risk plaque features, stress myocardial blood flow, and myocardial fibrosis were compared.

Results

Diabetic patients exhibited lower global stress myocardial blood flow [143.1 vs. 147.2 ml/100 ml/min; p = 0.001] and a higher incidence of myocardial ischemia (43.8% vs. 31.3%; p = 0.003). Diabetes remained an independent predictor of ischemia [odds ratio: 2.070; 95% confidence interval: 1.413-3.033; p < 0.001]. In CAD-RADS 0 patients, diabetes was associated with higher ischemia rates (33.7% vs. 14.5%; p = 0.004), and in CAD-RADS 1-2 patients, with more frequent napkin-ring signs (NRS) (10.3% vs. 3.5%; p = 0.042). Coronary calcification and myocardial fibrosis showed no significant difference between groups.

Conclusions

Diabetes is associated with impaired myocardial perfusion. Even in the absence of coronary atherosclerosis, diabetic patients have a higher prevalence of myocardial ischemia. In patients with nonobstructive CAD, diabetes was associated with a higher frequency of NRS. ADVANCES IN KNOWLEDGE Diabetes is associated with myocardial perfusion deficits and high-risk plaque independent of other cardiovascular risk determinants.