Predictive value of noninvasive peripheral atherosclerosis measurement for coronary artery disease in patients with long T2DM duration

Abstract

Abstract Background Vascular ultrasound is a commonly used tool to predict the existence and severity of coronary artery disease (CAD) by detecting the atherosclerosis of peripheral arteries. However, most studies on atherosclerosis are based on the general population, and the predictive efficacy of carotid or femoral ultrasound in type 2 Diabetes mellitus (T2DM) and its correlation with CAD severity are less elucidated. This study aimed to compare the predictive value of carotid or femoral artery ultrasound for CAD in T2DM patients free from known CAD, and to assess the relationship with the severity of coronary artery stenosis. Methods Cross-sectional study in adults with a T2DM duration of at least 5 years and without established CAD. All participants underwent carotid and femoral ultrasound and underwent coronary angiography for the first time. The carotid plaque score (CPS) was calculated by the sum of the maximum thickness of plaques on three segments of the carotid arteries on both sides. The Gensini score was used to assess the severity of coronary stenosis, and patients were divided into no or mild group, moderate group and severe group according to the tertile of the score. Results Multiple regression analysis showed that carotid plaque score, femoral plaque and smoking were independently and positively correlated with CAD. Carotid plaque score yielded the highest area under the curve for detecting significant coronary disease (AUC = 0.7323). In contrast, the area under the curve of femoral artery plaque and carotid intima-media thickness was lower than 0.7, which was at a lower prediction level. In the no or mild, moderate and severe groups, the CPS value gradually increased, and the difference between the groups was statistically significant (p < 0.05). The positive rate of femoral artery plaque in patients with moderate and severe CAD was significantly higher than that in the no or mild group (p < 0.0001). Conclusion In patients with long T2DM duration, carotid plaque score has a higher ability to predict the occurrence and severity of CAD. However, femoral artery plaque has special value in predicting moderate to severe coronary artery disease in patients with long-term T2DM.