Correlation between optical coherence tomography-derived intraluminal parameters and fractional flow reserve measurements in intermediate grade coronary lesions : a comparison between diabetic and non-diabetic patients

Fractional flow reserve (FFR) measurements accurately assess functional relevance in intermediate grade coronary lesions. A significant relationship between hemodynamic stenosis severity and optical coherence tomography (OCT)-derived intraluminal dimensions has recently been demonstrated. However, morphologic thresholds to identify significant stenoses are variable and exploration of this correlation in patients with diabetes mellitus (DM) remains currently incomplete. This study aimed at comparing the diagnostic value of intraluminal parameters as determined by OCT to predict FFR a parts per thousand currency sign0.8 in lesions of patients with versus without DM. In 100 patients (DM = 56, non-DM = 44) with 142 coronary de novo lesions (DM = 80, non-DM = 62) of intermediate grade as determined by quantitative coronary angiography, we performed OCT and FFR. Stenoses were defined functionally relevant if FFR was a parts per thousand currency sign0.8. FFR measurements in the overall study cohort, the DM and the non-DM group correlated significantly with minimal lumen area (MLA) [overall: r (2) = 0.339, DM: r (2) = 0.341, non-DM: r (2) = 0.355 (all p < 0.001)], percent area stenosis [overall: r (2) = 0.352, DM: r (2) = 0.376, non-DM: r (2) = 0.351 (all p < 0.001)] and minimal lumen diameter [overall: r (2) = 0.333, DM: r (2) = 0.277, non-DM: r (2) = 0.417 (all p < 0.001)] without differing statistically between diabetic and non-diabetic patients (p = ns). Receiver operating characteristic analysis demonstrated that among OCT-derived parameters, MLA predicted FFR a parts per thousand currency sign0.8 with the best diagnostic efficiency and with similar cut-off values for all patients [area under the curve (AUC) = 0.836, 95 % confidence interval (CI) = 0.772-0.901, cut-off value = 1.64 mm(2)] as well as for diabetic (AUC = 0.840, 95 % CI = 0.754-0.927, cut-off value = 1.59 mm(2)) and non-diabetic subjects (AUC = 0.833, 95 % CI = 0.734-0.932, cut-off value = 1.64 mm(2)). In both, diabetic and non-diabetic patients, FFR and OCT-derived intraluminal measurements are significantly correlated and OCT predicts hemodynamically relevant coronary stenosis with moderate diagnostic efficiency

Impact of type 2 diabetes mellitus and glucose control on fractional flow reserve measurements in intermediate grade coronary lesions

Hemodynamic relevance of intermediate grade coronary stenoses is accurately assessed by fractional flow reserve (FFR) measurements. However, the reliability of FFR in patients with type 2 diabetes mellitus (DM) and inadequate glucose control (IGC) is incompletely explored. This study aimed to investigate the impact of DM and IGC on the relationship between FFR measurements and quantitative coronary angiography (QCA)-derived morphological parameters. We performed FFR and QCA in 266 intermediate grade lesions of 224 patients (113 non-DM and 111 DM) with stable coronary artery disease. Diabetic patients were categorized into groups with adequate (Hb(A1C) < 7 %) and inadequate (Hb(A1c) a parts per thousand yen7 %) glucose control. Intermediate grade lesions from all-DM versus non-DM patients differed significantly in lesion length (LL) (10.91 +/- A 5.79 mm versus 9.23 +/- A 3.85 mm, p = 0.005) and hemodynamic relevance (FFR a parts per thousand currency sign0.8, 37.7 % versus 24.2 %, p = 0.018). FFR measurements in non-DM, all-DM and DM-IGC patients correlated significantly with percent diameter stenosis (%DS) [non-DM: r (2) = 0.075 (p = 0.007); all-DM: r (2) = 0.254 (p < 0.001), DM-IGC: r (2) = 0.301 (p < 0.001)] and LL [non-DM: r (2) = 0.356; all-DM: r (2) = 0.580, DM-IGC: r (2) = 0.513 (all p < 0.001)]. There was a better correlation between FFR and both %DS (p = 0.022) and LL (p = 0.011) among all-DM compared to non-DM patients. Receiver-operating curve analysis demonstrated that among all QCA-derived parameters LL had the best diagnostic efficacy to predict FFR a parts per thousand currency sign0.8 for non-DM (AUC 0.911, 95 % CI 0.861-0.960, best cut-off value 9.22 mm), all-DM (AUC 0.967, 95 % CI 0.942-0.991, best cut-off value 9.97 mm) and DM-IGC (AUC 0.960, 95 % CI 0.920-0.999, best cut-off value 9.97 mm) patients. Our data in intermediate grade lesions suggest that FFR is reliable in DM patients and LL is the best predictor for hemodynamic relevance in patients without and with diabetes, irrespective of the glycemic state

High cardiovascular risk of patients with type 2 diabetes is only partially attributed to angiographic burden of atherosclerosis

Background: Patients with type 2 diabetes (T2DM) are at high risk for cardiovascular events and present more severe coronary artery disease (CAD). The Gensini and COURAGE scores are established angiographic instruments to assess CAD severity, which may also predict future cardiovascular risk. However, it is unclear if these scores are able to depict the increased risk of patients with T2DM and stable CAD (T2DM-SAP). Methods: We performed quantitative coronary angiography and assessed the Gensini and COURAGE scores in 124 patients with T2DM-SAP. Angiographic data were compared to patients with stable angina without T2DM (Non-DM-SAP, n = 74), and to patients with acute coronary syndrome and T2DM (T2DM-ACS, n = 53). Results: T2DM-SAP patients had similar Gensini and COURAGE-scores compared to Non-DM-SAP-patients (Gensini: 14.44 +/- 27.34 vs 11.49 +/- 26.99, p = 0.465; COURAGE: 3.48 +/- 4.49 vs 3.60 +/- 4.72, p = 0.854). In contrast, T2DM-SAP patients had significantly lower Gensini (14.44 +/- 27.34 vs 30.94 +/- 48.74, p = 0.003) and lower COURAGE (3.48 +/- 4.49 vs 5.30 +/- 4.63, p = 0.016) scores compared to T2DM-ACS-patients. Conclusion: Both the Gensini and the COURAGE score fail to predict the high cardiovascular risk of patients with T2DM-SAP. Therefore, these scores should be used with caution in the assessment of future risk of patients with T2DM. However, among T2DM-ACS patients, both scores are increased, reflecting the high cardiovascular risk in this patient population

CARDIO VASCULAR DIABETOLOGY ORIGINAL INVESTIGATION Open Access

Plaque vulnerability of coronary artery lesions is related to left ventricular dilatation as determined by optical coherence tomography and cardiac magnetic resonance imaging in patients with type 2 diabete