Validating Improved Outcomes for Diabetic Patients
According to the American Diabetes Association, more than 75 percent of today’s 23.6 million U.S. residents with diabetes will die of heart disease. Many of these diabetic individuals are asymptomatic for coronary heart disease (CHD) until their first heart attack, and there is no accepted method of detecting CHD, to date.
“Patients with diabetes have a risk of cardiovascular disease that is two to four times greater than that of nondiabetic patients,” Donald Lappe, MD, chief of cardiology at Intermountain Medical Center, Salt Lake City, explains. “The ability to detect CHD in at-risk, asymptomatic patients will have a significant impact on the ability to improve their cardiac conditions and will help save lives.”
To assess the viability of using 64-detector row CT to diagnose CHD in asymptomatic patients, Toshiba America Medical Systems, Inc. in Tustin, Calif., funded faCTor64, a 1,100-patient prospective study conducted by researchers at Intermountain Healthcare, Salt Lake City. Investigators will identify asymptomatic diabetic patients using Intermountain’s diabetes database; then, they will compare two patient groups. Half will be evaluated for CHD using cardiac CT angiography (CTA) using the Toshiba Aquilion® CT system, while the other half will undergo traditional diabetes management. Researchers will follow both groups for five years to assess which group experiences better outcomes.
So far, 261 patients have been enrolled in the study, with 93 patients scanned; Intermountain hopes to complete enrollment by 2010. Using the Aquilion’s Volume Imaging protocol, Intermountain researchers have been able to create up to five different reconstructions using data from a single acquisition, allowing them to review more aspects of the patients’ cardiac function. Intermountain physicians also are able to develop their own CT protocols based on specific patient needs, and they can customize Toshiba’s proprietary SURECardio software to reduce the amount of contrast, and the radiation dose, that patients receive.
Researchers say the study’s initial results are promising. CHD has been diagnosed in approximately 75 percent of the scanned asymptomatic diabetic patients, and many of them also have high-grade, severe stenosis warranting revascularization. Several of the patients also have a defective anginal warning system, possibly providing a clue as to why they are asymptomatic, in spite of the severity of their CHD. The team at Intermountain also notes the results of the CTA scans have helped with patients’ health management; many patients who need to lose weight or make other lifestyle changes have been more compliant after seeing their CT results.
Tags: CT
Category: Education & Training —