Diabetes does not impact the diagnostic performance of contrast-based fractional flow reserve: insights from the CONTRAST study

Abstract

BackgroundAdenosine-free coronary pressure wire metrics have been proposed to test the functional significance of coronary artery lesions, but it is unexplored whether their diagnostic performance might be altered in patients with diabetes.MethodsWe performed a post-hoc analysis of the CONTRAST study, which prospectively enrolled an international cohort of patients undergoing routine fractional flow reserve (FFR) assessment for standard indications. Paired, repeated measurements of all physiology metrics (Pd/Pa, iFR, contrast-based FFR, and FFR) were made. A central core laboratory analyzed blinded pressure tracings in a standardized fashion.ResultsOf 763 subjects enrolled at 12 international centers, 219 (29%) had diabetes. The two groups were well-balanced for age, clinical presentation (stable or unstable), coronary vessel studied, volume and type of intracoronary contrast, and volume of intracoronary adenosine. A binary threshold of cFFR ≤ 0.83 produced an accuracy superior to both Pd/Pa and iFR when compared with FFR ≤ 0.80 in the absence of significant interaction with diabetes status; indeed, accuracy in subgroups of patients with or without diabetes was similar for cFFR (86.7 vs 85.4% respectively; p = 0.76), iFR (84.2 vs 80.0%, p = 0.29) and Pd/Pa (81.3 vs 78.9%, p = 0.55). There was no significant heterogeneity between patients with or without diabetes in terms of sensitivity and specificity of all metrics. The area under the receiver operating characteristic (ROC) curve was largest for cFFR compared with Pd/Pa and iFR which were equivalent (cFFR 0.961 and 0.928; Pd/Pa 0.916 and 0.870; iFR 0.911 and 0.861 in diabetic and non-diabetic patients respectively).ConclusionscFFR provides superior diagnostic performance compared with Pd/Pa or iFR for predicting FFR irrespective of diabetes (clinicaltrials.gov identifier NCT02184117).

Agreement of the Resting Distal to Aortic Coronary Pressure With the Instantaneous Wave-Free Ratio

“…acute coronary syndrome and stable angina). Given the high level of agreement between the two indices, coupled with existing evidence of their equivalent performance versus FFR (15)(16)(17)(18)(21)(22)(23)27) and cardiac positron emission tomography, (24) this study demonstrates that either resting physiologic index can be selected based on local preference and availability. These results further broaden the application of invasive coronary physiologic assessment when an operator decides not to induce hyperemia.…”

WITHDRAWN: Impact of type 2 diabetes mellitus on coronary function evaluated by quantitative flow ratio in patients underwent percutaneous coronary intervention

“…Thus, the accuracy of functional evaluation methods (i.e., QFR) in diabetics has been questioned [14][15][16] . However, several subgroup studies showed QFR maintains favorable performance in patients with T2DM, then dispelled the suspicion that T2DM may in uence the QFR measurement [17][18][19] . Therefore, using QFR to evaluate coronary function in diabetics seems to be feasible and reliable.…”

Coronary volume to left ventricular mass ratio in patients with diabetes mellitus

“…Moreover, this impaired response to hyperemia has been found even in the absence of atherosclerosis. 24 Microvascular dysfunction has been linked with reduced V/M ratio in a retrospective case-control study by Grover et al 1 that reported significantly lower V/M ratios in patients who met the criteria for microvascular angina as compared to their matched controls. This difference was mainly driven by lower coronary artery volumes.…”