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Comparative Study
. 2020 May-Jun;17(5):1479164120958425.
doi: 10.1177/1479164120958425.

An optical coherence tomography comparison of coronary arterial plaque calcification in patients with end-stage renal disease and diabetes mellitus

Joseph R Weber  1 , Brendan Martin  1 , Nicholas Kassis  1 , Kunal Shah  1 , Tomas Kovarnik  2 , Holly Mattix-Kramer  3 , John J Lopez  1
Affiliations
Comparative Study

An optical coherence tomography comparison of coronary arterial plaque calcification in patients with end-stage renal disease and diabetes mellitus

Joseph R Weber et al. Diab Vasc Dis Res. 2020 May-Jun.

Abstract

Background: Coronary arterial plaques in patients with end-stage renal disease (ESRD) are assumed to have increased calcification due to underlying renal disease or initiation of dialysis. This relationship may be confounded by comorbid type 2 diabetes mellitus (DM).

Methods: From a single-center OCT registry, 60 patients were analyzed. Twenty patients with ESRD and diabetes (ESRD-DM) were compared to 2 groups of non-ESRD patients: 20 with and 20 without diabetes. In each patient, one 20 mm segment within the culprit vessel was analyzed.

Results: ESRD-DM patients exhibited similar calcium burden, arc, and area compared to patients with diabetes alone. When compared to patients without diabetes, patients with diabetes exhibited a greater summed area of calcium (DM: Median 9.0, IQR [5.3-28] mm2 vs Non-DM: 3.5 [0.1-14] mm2, p = 0.04) and larger calcium deposits by arc (DM: Mean 45 ± SE 6.2° vs Non-DM: 21 ± 6.2°, p = 0.01) and area (DM: 0.58 ± 0.10 mm2 vs Non-DM: 0.26 ± 0.10 mm2, p = 0.03). Calcification deposits in ESRD-DM patients (0.14 ± 0.02 mm) and patients with diabetes (0.14 ± 0.02 mm) were more superficially located relative to patients without diabetes (0.21 ± 0.02 mm), p = 0.01 for both.

Conclusions: Coronary calcification in DM and ESRD-DM groups exhibited similar burden, deposit size, and depth within the arterial wall. The increase in coronary calcification and cardiovascular disease events seen in ESRD-DM patients may not be secondary to ESRD and dialysis, but instead due to a combination of declining renal function and diabetes.

Keywords: Optical coherence tomography; atherosclerosis; calcification; coronary artery calcium; coronary artery disease; diabetes mellitus type 2; end-stage renal disease.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Lopez is a consultant for Abbott-St Jude, runs educational training programs related to OCT, and is an investigator in clinical trials with OCT (research support and honoraria from Abbott-St Jude categorized as “modest”). No other authors have any conflicts to discuss.

Figures

Figure 1.
Figure 1.
Flow chart outlining the patient selection process. After excluding patients with poor image quality (n = 4) and those with ESRD alone (n = 3), a total of 20 patients with both ESRD and diabetes were identified. ESRD-DM patients were matched 1:1 to patients with and without diabetes, using first sex and then age ± 10 years as parameters. Best fit patients for either DM or non-DM groups were selected until a target number of 20 per group was reached. After matching was completed, patients with OCT runs with poor image quality or any target segments that were interrupted by prior stenting were excluded. If an initial match was excluded on the basis of poor image quality, it was then replaced by the next best fit based on sex and age.
Figure 2.
Figure 2.
Cross-sectional optical coherence tomography images of plaque types. (a) Calcified plaque was defined as a signal poor or heterogeneous area with a sharply delineated border. A calcium deposit is visible at 1 O’clock (white arrow). (b) Lipid plaque was defined as a signal poor area with poorly delineated borders. Circumferential lipid plaque with overlying fibrous cap is visible and highlighted at 2 O’clock (white arrow). (c) Fibrous plaque was defined as an area of high backscattering and homogenous signal. A focus of fibrous plaque is visible at 6 O’clock (white arrow). The white asterisks denote guidewire shadow artifact.
Figure 3.
Figure 3.
Cross-sectional optical coherence tomography images of calcium. (a) A calcium deposit is visible at 9 O’clock (white arrow). (b) The same calcium deposit after offline image analysis, including area (green circle), arc (angle θ), and depth (double-headed arrow) measurements. The white asterisks denote guidewire shadow artifact.
Figure 4.
Figure 4.
Graphical summary comparing mean (a) arc, (b) area, and (c) depth of calcification between patient groups. Blue circles, golden squares, and red diamonds represent mean values for DM, ESRD-DM, and non-DM groups respectively. Capped bars represent 95% confidence limits. ° indicates degrees. Data are also described in Table 3.
Figure 5.
Figure 5.
Correlation curve showing relationship between dialysis duration and summed area of calcium. Individual ESRD-DM patients are represented by blue circles. Blue shading represents 95% confidence limits. Summed area of calcium was positively correlated with dialysis duration for ESRD-DM patients (r = 0.61, p = 0.004).
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