Impact of Coronary CT Angiography-derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in Individuals with and without Diabetes

被引：6

作者：

Gulsin, Gaurav S. ^{[1
,2
,3
]}

Tzimas, Georgios ^{[1
,4
,5
]}

Holmes, Kenneth-Royce ^{[1
]}

Takagi, Hidenobu ^{[1
]}

Sellers, Stephanie L. ^{[1
,6
,7
]}

Blanke, Philipp ^{[1
]}

Koweek, Lynne M. H. ^{[8
]}

Norgaard, Bjarne L. ^{[9
]}

Jensen, Jesper ^{[9
]}

Rabbat, Mark G. ^{[10
,11
]}

Pontone, Gianluca ^{[12
]}

Fairbairn, Timothy A. ^{[13
]}

Chinnaiyan, Kavitha M. ^{[14
]}

Douglas, Pamela S. ^{[15
]}

Huey, Whitney ^{[23
]}

Matsuo, Hitoshi ^{[16
]}

Sand, Niels P. R. ^{[17
]}

Nieman, Koen ^{[18
]}

Bax, Jeroen J. ^{[19
]}

Amano, Tetsuya ^{[20
]}

Kawasaki, Tomohiro ^{[21
]}

Akasaka, Takashi ^{[22
]}

Rogers, Campbell ^{[23
]}

Berman, Daniel S. ^{[24
]}

Patel, Manesh R. ^{[8
]}

De Bruyne, Bernard ^{[25
]}

Mullen, Sarah ^{[23
]}

Leipsic, Jonathon A. ^{[1
,6
,7
]}

机构：

[1] Univ British Columbia, Dept Med & Radiol, 1081 Burrard St, Vancouver, BC V6T 1Z3, Canada

[2] Univ Leicester, Dept Cardiovasc Sci, Leicester, England

[3] Glenfield Hosp, NIHR Biomed Res Ctr, Leicester, England

[4] Lausanne Univ Hosp, Dept Heart Vessels, Cardiol Serv, Lausanne, Switzerland

[5] Univ Lausanne, Lausanne, Switzerland

[6] Univ British Columbia, Ctr Heart Lung Innovat, Vancouver, BC, Canada

[7] St Pauls Hosp, Vancouver, BC, Canada

[8] Duke Univ, Duke Clin Res Inst, Med Ctr, Dept Med,Sch Med,Div Cardiol, Durham, NC USA

[9] Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark

[10] Loyola Univ Chicago, Dept Cardiol, Chicago, IL USA

[11] Edward Hines Jr VA Hosp, Dept Cardiol, Hines, IL USA

[12] Ctr Cardiol Monzino, Dept Cardiol, Milan, Italy

[13] Univ Liverpool, Liverpool Heart & Chest Hosp, Dept Cardiol, Liverpool, England

[14] Beaumont Hlth, Dept Cardiol, Royal Oak, MI USA

[15] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA

[16] Gifu Heart Ctr, Dept Cardiol, Gifu, Japan

[17] Univ Southern Denmark, Univ Hosp SouthWest DK, Inst Reg Hlth Res, Cardiac Res Unit, Odense, Denmark

[18] Erasmus Univ, Med Ctr, Dept Cardiol, Rotterdam, Netherlands

[19] Leiden Univ, Med Ctr, Dept Cardiol, Leiden, Netherlands

[20] Aichi Med Univ, Dept Cardiol, Aichi, Japan

[21] Shin Koga Hosp, Cardiovasc Ctr, Fukuoka, Japan

[22] Wakayama Med Univ, Dept Cardiovasc Med, Wakayama, Japan

[23] HeartFlow Inc, Redwood City, CA USA

[24] Cedars Sinai Heart Inst, Dept Imaging, Div Nucl Imaging, Los Angeles, CA USA

[25] OLV Clin, Cardiovasc Ctr Aalst, Aalst, Belgium

来源：

RADIOLOGY-CARDIOTHORACIC IMAGING | 2023年 / 5卷 / 05期

关键词：

Fractional Flow Reserve; CT Angiography; Diabetes Mellitus; Coro-nary Artery Disease; COMPUTED-TOMOGRAPHY ANGIOGRAPHY; DISEASE; RISK;

D O I：

10.1148/ryct.220276

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Purpose: To compare the clinical use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) in individuals with and without diabetes mellitus (DM). Materials and Methods: This secondary analysis included participants (enrolled July 2015 to October 2017) from the prospective, multi-center, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials. gov identifier, NCT 02499679) who were evaluated for suspected coronary artery disease (CAD), with one or more coronary stenosis >= 30% on CCTA images, using CT-FFR. CCTA and CT-FFR findings, treatment strategies at 90 days, and clinical outcomes at 1-year follow-up were compared in participants with and without DM. Results: The study included 4290 participants (mean age, 66 years +/- 10 [SD]; 66% male participants; 22% participants with DM). Participants with DM had more obstructive CAD (one or more coronary stenosis >= 50%; 78.8% vs 70.6%, P < .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%, P < .001), and proportionally more vessels with CT-FFR <= 0.8 (74.3% vs 64.6%, P < .001). Treatment reclassification by CT-FFR occurred in two-thirds of participants which was consistent regardless of the presence of DM. There was a similar graded increase in coronary revascularization with declining CT-FFR in both groups. At 1 year, presence of DM was associated with higher rates of major adverse cardiovascular events (hazard ratio, 2.2; 95% CI: 1.2, 4.1; P = .01). However, no between group differences were observed when stratified by stenosis severity (<50% or >= 50%) or CT-FFR positivity. Conclusion: Both anatomic CCTA findings and CT-FFR demonstrated a more complex pattern of CAD in participants with versus without DM. Rates of treatment reclassification were similar regardless of the presence of DM, and DM was not an adverse prognostic indicator when adjusted for diameter stenosis and CT-FFR.

引用

页数：11

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