Coronary flow impairment in asymptomatic patients with early stage type-2 diabetes: Detection by FFR_CT

Abstract

Purpose: To determine the occurrence of physiological significant coronary artery disease (CAD) by coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) in asymptomatic patients with a new diagnosis (<1 year) of type-2 diabetes mellitus (T2DM). Methods: FFRCT-analysis was performed from standard acquired coronary CTA data sets. The per-patient minimum distal FFRCT-value (d-FFRCT) in coronary vessels (diameter ⩾1.8 mm) was registered. The threshold for categorizing FFRCT-analysis as abnormal was a d-FFRCT ⩽0.75. Total plaque volume and volumes of calcified plaque, non-calcified plaque, and low-density non-calcified plaque (LD-NCP) were assessed by quantitative plaque analysis. Results: Overall, 76 patients; age, mean (SD): 56 (11) years; males, n (%): 49(65), were studied. A total of 57% of patients had plaques. The d-FFRCT was ⩽0.75 in 12 (16%) patients. The d-FFRCT, median (IQR), was 0.84 (0.79–0.87). Median (range) d-FFRCT in patients with d-FFRCT ⩽0.75 was 0.70 (0.6–0.74). Patients with d-FFRCT⩽0.75 versus d-FFRCT >0.75 had numerically higher plaque volumes for all plaques components, although only significant for the LD-NCP component. Conclusion: Every sixth asymptomatic patient with a new diagnosis of T2DM has hemodynamic significant CAD as evaluated by FFRCT. Flow impairment by FFRCT was associated with coronary plaque characteristics.

Atherosclerotic plaque characteristics on quantitative coronary computed tomography angiography associated with ischemia on positron emission tomography in diabetic patients

“…In contrast to the current analysis, the abnormal FFR-CT ≤ 0.75, which is indicative of hemodynamic significant lesion, is associated with low-attenuation non-calcified plaques which is an established marker of high risk vulnerable plaque and has been predictive of adverse cardiac events in DM patients. [ 25 , 32 ].…”

On-site CT-derived cFFR in patients with suspected coronary artery disease: Feasibility on a 128-row CT scanner in everyday clinical practice

“…showed that diabetes has no negative impact on the diagnostic accuracy of machine learning-based C FFR [32] . Especially patients with type two diabetes mellitus have a high burden of CAD already in an early stage of the disease, and an advantage from hemodynamic evaluation of significant CAD by C FFR is proven [33] .…”

Multi-modality cardiac imaging in the management of diabetic heart disease

“…FFR-CT is an alternative functional technique, which combines anatomic and physiologic information in a single non-invasive test. Patients with diabetes have a high burden of coronary artery disease and it has been shown that every sixth asymptomatic patient at the time of the diagnosis of diabetes has haemodynamically significant plaque disease as evaluated by FFR-CT ( 44 ) (see an example of FFR-CT assessment in Figure 1 ). FFR-CT has improved specificity without impacting on the sensitivity of CTA in detecting haemodynamic significant coronary artery disease ( 45 ).…”