冠状动脉CT血管造影衍生的血流储备分数对糖尿病患者和非糖尿病患者下游管理及临床结局的影响
Impact of Coronary CT Angiography-derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in Individuals with and without Diabetes.
作者信息
Gulsin Gaurav S, Tzimas Georgios, Holmes Kenneth-Royce, Takagi Hidenobu, Sellers Stephanie L, Blanke Philipp, Koweek Lynne M H, Nørgaard Bjarne L, Jensen Jesper, Rabbat Mark G, Pontone Gianluca, Fairbairn Timothy A, Chinnaiyan Kavitha M, Douglas Pamela S, Huey Whitney, Matsuo Hitoshi, Sand Niels P R, Nieman Koen, Bax Jeroen J, Amano Tetsuya, Kawasaki Tomohiro, Akasaka Takashi, Rogers Campbell, Berman Daniel S, Patel Manesh R, De Bruyne Bernard, Mullen Sarah, Leipsic Jonathon A
机构信息
From the Department of Medicine and Radiology, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H., H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (G.T.); Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit, Institute of Regional Health Research, University Hospital of SouthWest DK, University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands (K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi, Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan (T.K.); Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R., S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium (B.D.B.).
出版信息
Radiol Cardiothorac Imaging. 2023 Oct 19;5(5):e220276. doi: 10.1148/ryct.220276. eCollection 2023 Oct.
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, multicenter, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials.gov identifier, NCT02499679) 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%, < .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%, < .001), and proportionally more vessels with CT-FFR ≤ 0.8 (74.3% vs 64.6%, < .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; = .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.Clinical trial registration no. NCT 02499679 Fractional Flow Reserve, CT Angiography, Diabetes Mellitus, Coronary Artery Disease See also the commentary by Ghoshhajra in this issue.© RSNA, 2023.
目的
比较冠状动脉CT血管造影（CCTA）衍生的血流储备分数（FFR）在糖尿病（DM）患者和非糖尿病患者中的临床应用。
材料与方法
这项二次分析纳入了前瞻性、多中心、国际性的冠状动脉护理中无创CT-FFR评估诊断价值（ADVANCE）注册研究（ClinicalTrials.gov标识符，NCT02499679）的参与者（2015年7月至2017年10月入组），这些参与者因疑似冠状动脉疾病（CAD）接受评估，在CCTA图像上有一处或多处冠状动脉狭窄≥30%，采用CT-FFR进行评估。比较了有DM和无DM参与者的CCTA和CT-FFR结果、90天时的治疗策略以及1年随访时的临床结局。
结果
该研究纳入了4290名参与者（平均年龄66岁±10[标准差]；66%为男性参与者；22%为DM患者）。DM患者有更多的阻塞性CAD（一处或多处冠状动脉狭窄≥50%；78.8%对70.6%，P<0.001）、多支血管CAD（三支血管阻塞性CAD；18.9%对11.2%，P<0.001），且CT-FFR≤0.8的血管比例更高（74.3%对64.6%，P<0.001）。三分之二的参与者根据CT-FFR进行了治疗重新分类，无论是否存在DM，情况均一致。两组中，随着CT-FFR降低，冠状动脉血运重建均有类似的分级增加。1年时，DM的存在与主要不良心血管事件发生率较高相关（风险比，2.2；95%置信区间：1.2，4.1；P=0.01）。然而，按狭窄严重程度（<50%或≥50%）或CT-FFR阳性分层时，未观察到组间差异。
结论
与无DM的参与者相比，有DM的参与者的解剖学CCTA结果和CT-FFR均显示出更复杂的CAD模式。无论是否存在DM，治疗重新分类率相似，并且在调整直径狭窄和CT-FFR后，DM不是不良预后指标。临床试验注册号：NCT 02499679血流储备分数、CT血管造影、糖尿病、冠状动脉疾病另见本期Ghoshhajra的评论。©RSNA，2023
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