Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBERCV, C/ Diego de Leon 62, 28006, Madrid, Spain.
Int J Cardiovasc Imaging. 2020 Jul;36(7):1193-1201. doi: 10.1007/s10554-020-01819-3. Epub 2020 Mar 27.
Currently there is lack of data regarding the use of optical coherence tomography (OCT) to depict the hemodynamic relevance of coronary stenoses in diabetic patients. We sought to assess the diagnostic accuracy of OCT-derived morphologic assessment in identifying hemodynamically significant coronary lesions as determined by both, the resting instantaneous wave-free ratio (iFR) and the hyperemic fractional flow reserve (FFR) in diabetic patients. Diabetic patients presenting with at least one intermediate coronary lesion were prospectively and consecutively enrolled. All lesions were systematically assessed by iFR, FFR and OCT. A total of 41 intermediate lesions were analysed. Mean iFR and FFR values were 0.90 ± 0.04 and 0.81 ± 0.06, respectively (intra-class correlation coefficient 0.49; 95% CI 0.22-0.79). A moderate correlation between iFR and OCT derived minimal lumen diameter (MLD, r = 0.49) and minimal lumen area (MLA, r = 0.50) was found. Conversely, there was a poor correlation between FFR and OCT-derived MLD (r = 0.34) and MLA (r = 0.32). The diagnostic efficiency of MLA and MLD to identify iFR significant stenoses showed an AUC of 0.82 (95% CI 0.69-0.95) for MLD and 0.83 (95% CI 0.71-0.96) for MLA. A worse diagnostic efficiency was found when FFR was used as the reference with an AUC of 0.71 (95% CI 0.54-0.87) for MLD and 0.70 (95% CI 0.53-0.87). OCT-derived MLA and MLD were the strongest independent anatomic predictors of abnormal iFR and FFR values. In diabetic patients, OCT-derived MLA and MLD showed a moderate diagnostic efficiency in identifying functionally significant coronary stenoses by FFR or iFR. In diabetics, anatomic OCT measurements better predicted resting than FFR-determined physiologically significant lesions.
目前,关于光学相干断层扫描(OCT)在描述糖尿病患者冠状动脉狭窄的血流动力学相关性方面的数据尚缺乏。我们旨在评估 OCT 衍生的形态学评估在识别糖尿病患者中由静息瞬时无波比(iFR)和充血性血流储备分数(FFR)确定的血流动力学意义重大的冠状动脉病变的诊断准确性。前瞻性连续纳入至少存在一处中度冠状动脉病变的糖尿病患者。所有病变均通过 iFR、FFR 和 OCT 进行系统评估。共分析了 41 处中度病变。平均 iFR 和 FFR 值分别为 0.90±0.04 和 0.81±0.06(组内相关系数 0.49;95%置信区间 0.22-0.79)。iFR 与 OCT 衍生的最小管腔直径(MLD,r=0.49)和最小管腔面积(MLA,r=0.50)之间存在中度相关性。相反,FFR 与 OCT 衍生的 MLD(r=0.34)和 MLA(r=0.32)之间相关性较差。MLD 和 MLA 识别 iFR 显著狭窄的诊断效率显示 MLD 的 AUC 为 0.82(95%置信区间 0.69-0.95),MLA 的 AUC 为 0.83(95%置信区间 0.71-0.96)。当使用 FFR 作为参考时,诊断效率较差,MLD 的 AUC 为 0.71(95%置信区间 0.54-0.87),MLA 的 AUC 为 0.70(95%置信区间 0.53-0.87)。OCT 衍生的 MLA 和 MLD 是异常 iFR 和 FFR 值的最强独立解剖预测因子。在糖尿病患者中,OCT 衍生的 MLA 和 MLD 对通过 FFR 或 iFR 识别功能意义重大的冠状动脉狭窄具有中度诊断效率。在糖尿病患者中,解剖 OCT 测量在静息状态下比 FFR 确定的生理意义重大的病变更能预测。