BACKGROUND: Although the development of a coronary guidewire mounted with a pressure sensor has facilitated the measurement of pressure-derived fractional flow reserve (FFR) to assess the functional severity of coronary artery stenoses, the theoretical limitations include diabetes mellitus because of the associated microvascular abnormalities. METHODS AND RESULTS: In the present study 304 vessels and their coronary territories in 96 diabetic and 149 nondiabetic patients were evaluated by pressure-derived FFR and thallium-201 single photon emission computed tomography (SPECT) to determine the applicability of measuring FFR in diabetic subjects. The best cut-off value for FFR to detect myocardial ischemia, as demonstrated by (201)Tl SPECT, was 0.725 in the diabetic and 0.745 in the nondiabetic patients. Sensitivity and specificity were similar for the 2 groups (83% and 75% (diabetic) vs 79% and 83%). However, diabetic patients with homoglobin (Hb) A(1c) >or=7.0% showed lower specificity in comparison with those having HbA(1c) <7.0% (64 vs 88%; p=0.045); however, sensitivities were similar (83 vs 83%; p=NS). CONCLUSIONS: The cut-off value of 0.75 for FFR can detect myocardial ischemia in diabetic patients, although the adequacy of glycemic control should be taken into consideration when assessing the FFR measurements.
BACKGROUND: Although the development of a coronary guidewire mounted with a pressure sensor has facilitated the measurement of pressure-derived fractional flow reserve (FFR) to assess the functional severity of coronary artery stenoses, the theoretical limitations include diabetes mellitus because of the associated microvascular abnormalities. METHODS AND RESULTS: In the present study 304 vessels and their coronary territories in 96 diabetic and 149 nondiabeticpatients were evaluated by pressure-derived FFR and thallium-201 single photon emission computed tomography (SPECT) to determine the applicability of measuring FFR in diabetic subjects. The best cut-off value for FFR to detect myocardial ischemia, as demonstrated by (201)Tl SPECT, was 0.725 in the diabetic and 0.745 in the nondiabeticpatients. Sensitivity and specificity were similar for the 2 groups (83% and 75% (diabetic) vs 79% and 83%). However, diabeticpatients with homoglobin (Hb) A(1c) >or=7.0% showed lower specificity in comparison with those having HbA(1c) <7.0% (64 vs 88%; p=0.045); however, sensitivities were similar (83 vs 83%; p=NS). CONCLUSIONS: The cut-off value of 0.75 for FFR can detect myocardial ischemia in diabeticpatients, although the adequacy of glycemic control should be taken into consideration when assessing the FFR measurements.
Authors: Joo Myung Lee; Ki Hong Choi; Bon-Kwon Koo; Hakim-Moulay Dehbi; Joon-Hyung Doh; Chang-Wook Nam; Eun-Seok Shin; Christopher M Cook; Rasha Al-Lamee; Ricardo Petraco; Sayan Sen; Iqbal S Malik; Sukhjinder S Nijjer; Hernán Mejía-Rentería; Eduardo Alegria-Barrero; Ali Alghamdi; John Altman; Sérgio B Baptista; Ravinay Bhindi; Waldemar Bojara; Salvatore Brugaletta; Pedro Canas Silva; Carlo Di Mario; Andrejs Erglis; Robert T Gerber; Olaf Going; Tobias Härle; Farrel Hellig; Ciro Indolfi; Luc Janssens; Allen Jeremias; Rajesh K Kharbanda; Ahmed Khashaba; Yuetsu Kikuta; Florian Krackhardt; Mika Laine; Sam J Lehman; Hitoshi Matsuo; Martijin Meuwissen; Giampaolo Niccoli; Jan J Piek; Flavo Ribichini; Habib Samady; James Sapontis; Arnold H Seto; Murat Sezer; Andrew S P Sharp; Jasvindar Singh; Hiroaki Takashima; Suneel Talwar; Nobuhiro Tanaka; Kare Tang; Eric Van Belle; Niels van Royen; Hugo Vinhas; Christiaan J Vrints; Darren Walters; Hiroyoshi Yokoi; Bruce Samuels; Chris Buller; Manesh R Patel; Patrick Serruys; Javier Escaned; Justin E Davies Journal: JAMA Cardiol Date: 2019-09-01 Impact factor: 14.676
Authors: Giuseppe Gargiulo; Eugenio Stabile; Marco Ferrone; Emanuele Barbato; Frederik M Zimmermann; Julien Adjedj; Barry Hennigan; Mitsuaki Matsumura; Nils P Johnson; William F Fearon; Allen Jeremias; Bruno Trimarco; Giovanni Esposito Journal: Cardiovasc Diabetol Date: 2017-01-13 Impact factor: 9.951