Echocardiographic factors related to coronary artery calcium burden in patients with newly diagnosed type 2 diabetes mellitus
Authors: Hyseni V , Bakalli A , Gjikolli B , Olloni-Nikaj R , Vela-Gaxha Z , Krasniqi X , Elezi S 
Published: January 2025

Abstract

Introduction
Newly diagnosed type 2 diabetes mellitus (NDT2DM) could be linked to cardiac complications. A multinational cohort of adults under 55 years old, who had acute myocardial infarction, showed NDT2DM in 14.5% of patients. Timely diagnosis and treatment of diabetes mellitus (DM) can help mitigate the risk of long-term complications, particularly in the context of ischemic heart disease. The computed tomography (CTCS) calcium score in the coronary arteries is a reliable predictor of coronary heart disease events. Echocardiography is a time-efficient and cost-effective technique, delivering accurate and reproducible diagnostic and prognostic insights in individuals with DM.

Purpose
The objective of this study was to determine the echocardiographic factors associated with subclinical atherosclerotic plaques in coronary arteries, as uncovered by CTCS, in patients with NDT2DM.

Methods
In this prospective cross-sectional study 101 patients with NDT2DM, according to the criteria of the American Diabetes Association, were included. CTCS was performed on all patients by 64-slice cardiac CT, with a thickness of 2-5 mm. Calcification was identified as a structure &gt;1 mm attached to or located within the lumen of a coronary vessel with intensity &gt;130 HU. The Agatston method was used to determine the CTCS. Patients were categorized into five groups based on their calcium score (0, 0-10, 11-100, 101-400 and &gt;400), and all obtained echocardiographic features were compared between the groups. Exclusion criteria included: stable angina pectoris, acute coronary disease, severe anemia, patients with history of stroke, moderate/severe renal insufficiency, liver insufficiency, claustrophobic patients, and pregnant women.

Results
Of the 101 asymptomatic patients with NDT2DM, 53 (52.5%) were males, with mean age of 54.4 ± 11.6 years and mean duration of diabetes of 2.8 ± 5.3 months. The total volume and mass of calcium in our patients was 210 and 180, respectively. In the table the differences between the 5 groups regarding echocardiographic characteristics are shown. The only echocardiographic parameters that differed significantly between the groups were the left atrium (P=0.001), interventricuar (P=0.005) and posterior wall thickness (P=0.017), as well as the degree of left ventricular hypertrophy (P=0.007). However, mean left atrial diameter across the groups was within reference range values, whereas left ventricular wall thickness was mildly hypertrophied in the &gt;400 CTCS group.

Conclusions
NDT2DM patients with higher calcium burden tend to have thicker left ventricular walls. Hence, for individuals with NDT2DM, it is advisable to conduct echocardiography at the earliest opportunity, given its accessibility and cost-effectiveness. Special consideration should be given to even mild left ventricular hypertrophy, prompting additional assessments for coronary artery disease. Early and thorough cardiovascular management should be initiated accordingly.