Abstract

Coronary artery disease (CAD) is the leading cause of death globally, with individuals with Type 2 Diabetes Mellitus (T2DM) facing significantly higher risks of aggressive disease progression. Traditional diagnostic approaches often fail to accurately predict plaque progression in T2DM, highlighting the need for novel biomarkers. This study investigates the predictive value of coronary artery vorticity, a measure of the local rotation in fluid flow, on functional plaque progression in T2DM patients. Materials & Methods: A cohort of 200 T2DM patients, aged 40-65 years and without prior major cardiovascular events, was recruited. High-resolution coronary angiography and intravascular ultrasound (IVUS) were employed to measure coronary artery vorticity and assess plaque characteristics at baseline and over a 24-month follow-up. Computational fluid dynamics (CFD) simulations quantified vorticity. The study analyzed the correlation between baseline vorticity and subsequent plaque progression, comparing the predictive power of vorticity against traditional risk factors. Results: Baseline vorticity was significantly associated with plaque volume and composition changes over time. Higher vorticity values correlated with an increase in plaque volume and a higher proportion of calcified plaque. Vorticity measurements outperformed traditional risk factors (HbA1c, BMI, and duration of diabetes) in predicting plaque progression, with an Area Under the Curve (AUC) of 0.85. Furthermore, elevated vorticity was linked to a higher incidence of adverse cardiovascular events within the follow-up period. Conclusion: Coronary artery vorticity emerges as a potent predictive biomarker for plaque progression in T2DM patients, offering superior predictive accuracy over traditional risk factors. This study underscores the potential of vorticity as a tool for early identification and personalized management of patients at risk, paving the way for targeted interventions to mitigate the progression of CAD in the T2DM population

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