Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
KCRI, Kraków, Poland
Pol Arch Intern Med. 2023 Nov 29;133(11). doi: 10.20452/pamw.16502. Epub 2023 May 22.
Current guidelines recommend physiological evaluation of borderline coronary artery stenoses using hyperemic (fractional flow reserve [FFR]) and nonhyperemic (instantaneous wave‑free ratio [iFR] and resting full‑cycle ratio [RFR]) methods. However, comorbidities, such as diabetes mellitus (DM), may influence the results of the assessment.
We sought to investigate the impact of DM and insulin treatment on the discordance between FFR and iFR/RFR.
A total of 417 intermediate stenoses in 381 patients underwent FFR and iFR/RFR assessment. FFR lower than or equal to 0.8 and iFR/RFR lower than or equal to 0.89 indicated significant ischemia. The patients were categorized based on DM diagnosis and insulin treatment status.
Of the 381 patients, 154 (40.4%) had DM. Among these, 58 patients (37.7%) received insulin treatment. Diabetic patients had higher body mass index and glycated hemoglobin levels, and lower ejection fraction. FFR and iFR/RFR analyses were conducted in 417 vessels with available measurements for both tests. A good correlation between FFR and iFR/RFR was confirmed in both diabetic (R = 0.77) and nondiabetic (R = 0.74) patients. Discordance between FFR and iFR/RFR occurred in approximately 20% of cases, and the frequency of discordance was not affected by the diabetic status. However, insulin‑treated DM was independently associated with a higher risk of negative FFR and positive iFR/RFR discordance (odds ratio, 4.61; 95% CI, 1.38-15.4; P = 0.01). Also, the optimal cutoff value for FFR identifying significant ischemia in DM patients treated with insulin was higher (0.84) than the generally recommended value.
The rate of FFR and iFR/FFR discordance was similar regardless of the diabetes status, and insulin‑treated DM was associated with an increased risk of negative FFR and positive iFR/RFR discordance.
目前的指南建议使用充血（血流储备分数 [FFR]）和非充血（瞬时无波比 [iFR] 和静息全周期比 [RFR]）方法对临界冠状动脉狭窄进行生理评估。然而，合并症，如糖尿病（DM），可能会影响评估结果。
我们旨在研究 DM 和胰岛素治疗对 FFR 和 iFR/RFR 不匹配的影响。
共有 381 名患者的 417 处中度狭窄接受了 FFR 和 iFR/RFR 评估。FFR 等于或小于 0.8 和 iFR/RFR 等于或小于 0.89 表明存在明显缺血。根据 DM 诊断和胰岛素治疗情况对患者进行分类。
在 381 名患者中，有 154 名（40.4%）患有 DM。其中，58 名患者（37.7%）接受胰岛素治疗。糖尿病患者的体重指数和糖化血红蛋白水平较高，射血分数较低。对 417 个有两种检测方法的可用测量值的血管进行了 FFR 和 iFR/RFR 分析。在糖尿病（R = 0.77）和非糖尿病患者（R = 0.74）中，均确认了 FFR 和 iFR/RFR 之间的良好相关性。FFR 和 iFR/RFR 之间的不匹配约发生在 20%的病例中，且不匹配的频率不受糖尿病状态的影响。然而，接受胰岛素治疗的 DM 与更高的 FFR 阴性和 iFR/RFR 阳性不匹配风险独立相关（比值比，4.61；95%置信区间，1.38-15.4；P = 0.01）。此外，在接受胰岛素治疗的 DM 患者中，用于识别明显缺血的 FFR 的最佳截断值也高于一般推荐值（0.84）。
无论糖尿病状态如何，FFR 和 iFR/RFR 不匹配的发生率相似，而接受胰岛素治疗的 DM 与 FFR 阴性和 iFR/RFR 阳性不匹配的风险增加相关。
