Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
Cardiovasc Diabetol. 2024 Nov 8;23(1):404. doi: 10.1186/s12933-024-02493-8.
Coronary artery calcification is commonly found in patients with type 2 diabetes mellitus (T2DM), which may compromise the diagnostic accuracy of coronary computed tomography angiography (CTA). Computed tomography-derived fractional flow reserve (CT-FFR), which integrates coronary anatomy with functional assessment, holds the potential to become a powerful diagnostic tool for evaluating calcified lesions.
We aim to assess the prognostic value of CT-FFR for calcific lesions in patients with T2DM and unstable angina (UA).
We conducted a retrospective study involving 3,392 patients who were diagnosed with T2DM and UA who underwent coronary CTA, with at least one visible calcification site. Of those, 1,091 patients and 1,372 vessels were recommended by cardiovascular specialists and completed invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) measurements. Simultaneously, those patients also underwent CT-FFR measurements and were divided into two groups based on CT-FFR values: one group with CT-FFR > 0.80 and the other with CT-FFR ≤ 0.80. Demographics, clinical data, the diagnostic performance of CT-FFR, analysis of calcified lesions on CTA, and major adverse events during follow-up were recorded.
The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the curve (AUC) of CT-FFR were 84.8%, 84.6%, 85.1%, 84.7%, 85.0%, and 84.8%, respectively, per patient, and 82.2%, 80.3.2%, 81.8%, 79.7%, 81.1%, and 82.9% respectively, per vessel. For lesion and calcification characteristics, the degree of stenosis, lesion length, rate of bifurcation lesions, diffusive lesions, occlusion, calcium volume, and coronary artery calcification score (CACS) were significantly higher in the CT-FFR ≤ 0.8 group compared to the CT-FFR > 0.8 group. In contrast, the minimum cross-sectional area was smaller in the CT-FFR ≤ 0.8 group than in the CT-FFR > 0.8 group. Major adverse cardiovascular and cerebrovascular events (MACCE) at the 3-year follow-up was significantly higher in the CT-FFR ≤ 0.8 group compared to the CT-FFR > 0.8 group. The CT-FFR value is an independent predictor of MACCE at the 3-year follow-up.
CT-FFR demonstrated significant diagnostic performance using invasive FFR as the reference standard and proved to be an important predictive tool for assessing prognosis not only in calcified lesions but also in lesions with a CACS score of zero in patients with T2DM and UA. CT-FFR may serve as a valuable tool for guiding treatment decisions in these patients.
冠状动脉钙化在 2 型糖尿病（T2DM）患者中很常见，这可能会影响冠状动脉计算机断层扫描血管造影（CTA）的诊断准确性。基于冠状动脉解剖结构与功能评估的计算机断层扫描衍生的血流储备分数（CT-FFR）有望成为评估钙化病变的有力诊断工具。
我们旨在评估 CT-FFR 对 T2DM 合并不稳定型心绞痛（UA）患者钙化病变的预后价值。
我们进行了一项回顾性研究，纳入了 3392 例 T2DM 合并 UA 并接受冠状动脉 CTA 检查的患者，这些患者至少有一个可见的钙化部位。其中，1091 例患者和 1372 个血管被心血管专家推荐，并完成了有创冠状动脉造影（ICA）和有创血流储备分数（FFR）测量。同时，这些患者还接受了 CT-FFR 测量，并根据 CT-FFR 值分为两组：一组 CT-FFR>0.80，另一组 CT-FFR≤0.80。记录患者的人口统计学、临床数据、CT-FFR 的诊断性能、CTA 上钙化病变的分析以及随访期间的主要不良心血管事件。
按患者计算，CT-FFR 的诊断准确性、敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC）分别为 84.8%、84.6%、85.1%、84.7%、85.0%和 84.8%，按血管计算则分别为 82.2%、80.3.2%、81.8%、79.7%、81.1%和 82.9%。在病变和钙化特征方面，CT-FFR≤0.8 组的狭窄程度、病变长度、分叉病变发生率、弥漫性病变、闭塞、钙体积和冠状动脉钙化评分（CACS）明显高于 CT-FFR>0.8 组。相反，CT-FFR≤0.8 组的最小截面积小于 CT-FFR>0.8 组。与 CT-FFR>0.8 组相比，CT-FFR≤0.8 组的 3 年主要不良心血管和脑血管事件（MACCE）发生率明显更高。CT-FFR 值是 3 年随访时 MACCE 的独立预测因子。
CT-FFR 作为有创 FFR 的参考标准具有显著的诊断性能，对于评估 T2DM 和 UA 患者的预后，不仅在钙化病变中，而且在 CACS 评分为零的病变中，都是一种重要的预测工具。CT-FFR 可能成为指导这些患者治疗决策的有用工具。
