Correction:Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study

Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany.The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases.Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955-0.992]; p = 0.006) arterial hypertension (1.90 [1.190-3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504-7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068-1.114]; p<0.0001 and 1.18 [1.137-1.222]; p<0.0001, respectively).Our calculations suggest that approximately 142 000 persons aged between 35 and 74 years have vision threatening diabetic retinal disease in Germany [corrected].Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus

Dual Source CT Coronary Angiography for the Detection of Transplant Vasculopathy in Comparison to Intravascular Ultrasound

1. Hintergrund und Ziele Die koronare Transplantatvaskulopathie (TVP) ist ein entscheidender Faktor für das Langzeit-Überleben herztransplantierter Patienten. Die Prävalenz der koronaren TVP reicht von 8% im ersten Jahr nach Herztransplantation bis zu 43% nach acht Jahren. Zur Erfassung der klinisch häufig stummen TVP müssen sich die Patienten regelmäßig einer invasiven Herzkatheteruntersuchung inklusive intravaskulärem Ultraschall (IVUS) unterziehen. Die Multi-Slice Computertomographie (MSCT) hat gezeigt, dass sie die nichtinvasive Darstellung der Herzkranzgefäße und die Erkennung höhergradiger Koronarstenosen erlaubt. Damit stellt das Verfahren eine mögliche Alternative zur Herzkatheteruntersuchung auch bei herztransplantierten Patienten dar. Allerdings war die Genauigkeit bisheriger CT-Generationen durch die häufig hohen, therapeutisch nur eingeschränkt beeinflussbaren Herzfrequenzen von Patienten nach Herztransplantation limitiert. Die Dual Source Computertomographie (DSCT) hat gegenüber der Single Source Computertomographie eine deutlich höhere zeitliche Auflösung. Ziel der Studie war es, die klinische Genauigkeit der DSCT im Vergleich zum klinischen Standard der invasiven Methoden bei der Erfassung koronarer TVP zu beurteilen. 2. Methoden (Patienten, Material und Untersuchungsmethoden) 30 herztransplantierte Patienten wurden 12 bis 74 Monate nach Transplantation zu-nächst mittels DSCT ohne zusätzliche Applikation von ß-Blockern untersucht. An-schließend erfolgte die Herzkatheteruntersuchung einschließlich IVUS. Die Datensätze der Computertomographie wurden mit Hilfe quantitativer Parameter hinsichtlich ihrer Bildqualität beurteilt. Außerdem wurden die Daten auf das Vorhandensein koronarer Plaques als Zeichen einer TVP untersucht und mit den Ergebnissen der im Rahmen der Herzkatheteruntersuchung durchgeführten intravaskulären Ultraschalluntersuchung verglichen. Ebenso wurden die CT-Datensätze auf das Vorliegen von Koronararterienstenosen untersucht und mit den Ergebnissen der quantitativen Koronarangiographie (QCA) verglichen. 3. Ergebnisse und Beobachtungen 96% der Koronararteriensegmente wurden in ihrer Bildqualität als sehr gut oder gut eingestuft. Die Evaluierung der DSCT erbrachte für die Erfassung der TVP in der seg-ment-basierten Analyse im Vergleich zum Goldstandard des IVUS eine Sensitivität von 85% bzw. einen negativen prädiktiven Wert (NPW) von 91%. In der patienten-basierten Analyse wurden alle Patienten mit einer Transplantatvaskulopathie identifiziert. Im Hinblick auf den Ausschluss einer signifikanten Koronararterienstenose erreichte die CT-Koronarangiographie in der patienten-basierten Analyse einen NPW von 100% im Vergleich zur invasiven Koronarangiographie. 4. Praktische Schlussfolgerungen Die DSCT erlaubt eine zuverlässige Beurteilung der Herzkranzgefäße von herztrans-plantierten Patienten mit diagnostischer Bildqualität und hoher Genauigkeit. Um das Potenzial der nicht-invasiven DSCT in der jährlichen Verlaufskontrolle von Herztrans-plantierten als Alternative zu den invasiven Methoden abschätzen zu können, müssen weitere Studien mit größeren Patientenzahlen folgen.1. Background Cardiac allograft vasculopathy (CAV) is the main factor limiting the long-term success of heart transplantation. The prevalence of CAV ranges from 8% one year after heart transplantation to 43% after eight years. Because of the silent nature of CAV annual coronary angiograms are the standard of reference for diagnosis and follow-up of CAV. Multi-detector computed tomography permits the visualization of the coronary arteries and the detection of coronary artery stenoses. However, the evaluation of heart transplant recipients as to the presence of CAV is challenging because of their usually high heart rate and a resistance to ß-blockers. Dual source computed tomography (DSCT) provides a higher temporal resolution. The study was performed to assess the ability of DSCT to detect CAV in transplant recipients. 2. Methods A total of 30 heart transplant recipients were investigated by DSCT without the addi-tional application of ß-blockers 12 to 74 months after surgery. The computed tomogra-phy data were analyzed for image quality using prespecified quality parameters. Than the coronary segments were evaluated for the presence of coronary plaques by DSCT. Results were compared to invasive angiography. Furthermore computed tomography scans were evaluated for the presence of coronary artery stenosis compared to quantitative coronary angiography (QCA). Finally, since intravascular ultrasound (IVUS) is the gold standard for the evaluation of heart recipients, computed tomography was also evaluated to the presence of coronary artery plaques in the IVUS investigated arteries. The analysis of the CT- and the invasive coronary angiography-data, including IVUS, was performed by two independent investigators. 3. Results 96% of the coronary segments were graded as of excellent or good image quality. 4% of the coronary segments were unevaluable. Compared to invasive coronary angiography, DSCT correctly detected 67 of 72 CAV segments (93%). In invasive coronary angiography none of the patients demonstrated a lumen reduction of more than 50% in the major coronary arteries. CT correctly excluded a significant stenosis in all 30 patients. IVUS was performed in all 30 patients. Thereby, CAV was detected in 17 of the 30 patients (57%) and in 41 of the included 110 (37%) coronary artery segments. DSCT-data were evaluable in 97% of segments with corresponding IVUS correlation. DSCT identified all 17 patients with CAV in IVUS. In the per-segment analysis, 85% of the plaques identified by IVUS were detected by DSCT. 4. Conclusion DSCT permits the investigation of transplant recipients concerning the presence of CAV with good image quality and diagnostic accuracy. Further studies are necessary to evaluate the potential of DSCT in the follow-up of heart transplant patients as an alternative to invasive coronary angiography

Prevalence of diabetic retinopathy in screening-detected diabetes mellitus : results from the Gutenberg Health Study (GHS)

Aims/hypothesis Individuals with type 2 diabetes mellitus may experience an asymptomatic period of hyperglycaemia, and complications may already be present at the time of diagnosis. We aimed to determine the prevalence of diabetic retinopathy in patients with newly diagnosed (screening-detected) type 2 diabetes. Methods The Gutenberg Health Study is a population-based study with 15,010 participants aged between 35 and 74 years. We determined the weighted prevalence of diabetic retinopathy by assessing fundus photographs. Screening-detected type 2 diabetes was defined as an HbA1c concentration of 6.5% (47.5 mmol/mol) or more, no medical diagnosis of diabetes and no intake of insulin or oral glucose-lowering agents. Results Of 14,948 participants, 1377 (9.2%) had diabetes mellitus. Of these, 347 (25.2%) had newly diagnosed type 2 diabetes detected by the screening. Overall, the weighted prevalence of screening-detected type 2 diabetes was 2.1%. Fundus photos were evaluable for 285 (82.1%) participants with newly diagnosed diabetes. The weighted prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13.0%; 12% of participants had a mild non-proliferative diabetic retinopathy and 0.6% had a moderate non-proliferative diabetic retinopathy. Diabetic retinopathy was proliferative in 0.3%. No cases of severe non-proliferative diabetic retinopathy or diabetic maculopathy were found. Thirty (14.9%) of 202 and six (7.2%) of 83 individuals with and without concomitant arterial hypertension, respectively, had diabetic retinopathy (OR 2.54, 95% CI 1.06, 7.14). Visual acuity did not differ between individuals with and without diabetic retinopathy. Conclusions/interpretation In this large European study, the prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13%. Only a very small proportion of participants with detected diabetic retinopathy needed treatment

Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study.

Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany.The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases.Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955-0.992]; p = 0.006) arterial hypertension (1.90 [1.190-3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504-7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068-1.114]; p<0.0001 and 1.18 [1.137-1.222]; p<0.0001, respectively).Our calculations suggest that approximately 142 000 persons aged between 35 and 74 years have vision threatening diabetic retinal disease in Germany [corrected].Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus

Weighted prevalence of vision-threatening disease in different age decades.

<p>Weighted prevalence of vision-threatening disease in different age decades.</p

Grading criteria of diabetic retinopathy (DR) and maculopathy (simplified EDTRS criteria [14].

<p>Grading criteria of diabetic retinopathy (DR) and maculopathy (simplified EDTRS criteria [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127188#pone.0127188.ref014" target="_blank">14</a>].</p

Gutenberg Health Study cohort.

<p>Gutenberg Health Study cohort.</p

Prevalences of diabetic retinopathy and maculopathy in other population-based studies.

<p>Prevalences of diabetic retinopathy and maculopathy in other population-based studies.</p