CT-derived fractional flow reserve for prediction of major adverse cardiovascular events in diabetic patients

• Published in: Cardiovascular diabetology Vol. 22; no. 1; pp. 65 - 13
• Main Authors: Lan, Ziting, Ding, Xiaoying, Yu, Yarong, Yu, Lihua, Yang, Wenli, Dai, Xu, Ling, Runjianya, Wang, Yufan, Yang, Wenyi, Zhang, Jiayin
• Format: Journal Article
• Language: English
• Published: England BioMed Central 21.03.2023; BMC
• Subjects: Aged; Angiography; Calcification; Cardiovascular disease; Computed tomography; Computed Tomography Angiography - methods; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary computed tomography angiography; Coronary Stenosis; Coronary Vessels; Diabetes; Diabetes Mellitus; Fractional flow reserve; Fractional Flow Reserve, Myocardial; Glycated Hemoglobin; Heart attacks; Heart diseases; Heart failure; Hemodynamics; High-risk plaque; Hospitals; Humans; Male; Mathematical models; Medical imaging; Middle Aged; Patients; Plaque, Atherosclerotic; Predictive Value of Tests; Software; Tomography; Tomography, X-Ray Computed; Vein & artery diseases; United States > US; Germany; Diabetes; High-risk plaque; Fractional flow reserve; Coronary computed tomography angiography
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-023-01801-y

To investigate the prognostic value of computed tomography fractional flow reserve (CT-FFR) in patients with diabetes and to establish a risk stratification model for major adverse cardiac event (MACE). Diabetic patients with intermediate pre-test probability of coronary artery disease were prospectively enrolled. All patients were referred for coronary computed tomography angiography and followed up for at least 2 years. In the training cohort comprising of 957 patients, two models were developed: model1 with the inclusion of clinical and conventional imaging parameters, model2 incorporating the above parameters + CT-FFR. An internal validation cohort comprising 411 patients and an independent external test cohort of 429 patients were used to validate the proposed models. 1797 patients (mean age: 61.0 ± 7.0 years, 1031 males) were finally included in the present study. MACE occurred in 7.18% (129/1797) of the current cohort during follow- up. Multivariate Cox regression analysis revealed that CT-FFR ≤ 0.80 (hazard ratio [HR] = 4.534, p < 0.001), HbA1c (HR = 1.142, p = 0.015) and low attenuation plaque (LAP) (HR = 3.973, p = 0.041) were the independent predictors for MACE. In the training cohort, the Log-likelihood test showed statistical significance between model1 and model2 (p < 0.001). The C-index of model2 was significantly larger than that of model1 (C-index = 0.82 [0.77-0.87] vs. 0.80 [0.75-0.85], p = 0.021). Similar findings were found in internal validation and external test cohorts. CT-FFR was a strong independent predictor for MACE in diabetic cohort. The model incorporating CT-FFR, LAP and HbA1c yielded excellent performance in predicting MACE.