Tomizawa Nobuo, Fujimoto Shinichiro, Takahashi Daigo, Nozaki Yui, Fan Ruiheng, Kudo Ayako, Kawaguchi Yuko, Takamura Kazuhisa, Hiki Makoto, Kadowaki Satoshi, Ikeda Fuki, Kumamaru Kanako K, Watada Hirotaka, Minamino Tohru, Aoki Shigeki
Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Am Heart J Plus. 2023 Sep 28;35:100328. doi: 10.1016/j.ahjo.2023.100328. eCollection 2023 Nov.
We aimed to investigate the diagnostic value of energy loss (EL) and baseline CT fractional flow reserve (CT-FFR) computed using computational fluid dynamics to predict functional progression of coronary stenosis in patients with type 2 diabetes mellitus.
This single-center prospective study included 61 patients with type 2 diabetes mellitus (mean age, 61 years ±9 [SD]; 43 men) showing 20-70 % stenosis who underwent serial coronary CT performed at 2-year interval between October 2015 and March 2020. A mesh-free simulation was performed to calculate the CT-FFR and EL. Functional progression was defined as ≥ 0.05 decrease in CT-FFR on the second coronary CT. Models using baseline CT-FFR and EL were compared by analyzing the receiver operating characteristic (ROC) curve.
Of the 94 vessels evaluated, 25 vessels (27 %) showed functional progression. EL at distal stenosis (EL) of vessels with functional progression was higher than that of vessels without functional progression (27.6 W/m [interquartile range (IQR): 15.0, 53.0] vs. 5.7 W/m [IQR: 2.3, 10.1], < 0.001). Multivariable analysis showed that EL (per unit Ln(EL); odds ratio, 11.8; 95 % CI: 4.0-34.9; p < 0.001) remained as a predictor of functional progression after adjustment for diameter stenosis and baseline CT-FFR. The area under the ROC curve using EL (0.89; 95 % CI: 0.82-0.96) was higher than that using baseline CT-FFR (0.71; 95 % CI: 0.59-0.83; < 0.001).
When EL and baseline CT-FFR were considered, EL was a better predictor of functional progression of coronary stenosis.
我们旨在研究能量损失（EL）和使用计算流体动力学计算的基线CT血流储备分数（CT-FFR）对预测2型糖尿病患者冠状动脉狭窄功能进展的诊断价值。
这项单中心前瞻性研究纳入了61例2型糖尿病患者（平均年龄61岁±9[标准差]；43例男性），这些患者的冠状动脉狭窄程度为20%-70%，于2015年10月至2020年3月期间每隔2年进行一次冠状动脉CT检查。采用无网格模拟计算CT-FFR和EL。功能进展定义为第二次冠状动脉CT检查时CT-FFR下降≥0.05。通过分析受试者工作特征（ROC）曲线比较使用基线CT-FFR和EL的模型。
在评估的94条血管中，25条血管（27%）出现功能进展。出现功能进展的血管远端狭窄处的EL高于未出现功能进展的血管（27.6W/m[四分位间距（IQR）：15.0，53.0]vs.5.7W/m[IQR：2.3，10.1]，<0.001）。多变量分析显示，在调整了直径狭窄和基线CT-FFR后，EL（每单位Ln(EL)；比值比，11.8；95%置信区间：4.0-34.9；p<0.001）仍然是功能进展的预测指标。使用EL的ROC曲线下面积（0.89；95%置信区间：0.82-0.96）高于使用基线CT-FFR的面积（0.71；95%置信区间：0.59-0.83；<0.001）。
在考虑EL和基线CT-FFR时，EL是冠状动脉狭窄功能进展的更好预测指标。
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