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Fractional flow reserve derived from coronary computed tomography angiography: diagnostic performance in hypertensive
Ashkan Eftekhari1, James Min2, Stephan Achenbach3
1Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
Insights
Fractional flow reserve derived from coronary computed tomography (FFRCT) accurately diagnoses coronary artery disease (CAD) in patients with hypertension (HTN) and diabetes (DM). This non-invasive method is reliable for diverse CAD populations, including those with microvascular risks.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Accuracy
- Non-invasive Cardiology
Background:
- Fractional flow reserve (FFR) derived from coronary computed tomography (FFRCT) demonstrates high diagnostic performance in stable coronary artery disease (CAD).
- The diagnostic utility of FFRCT in patients with hypertension (HTN) and diabetes mellitus (DM), conditions associated with microvascular impairment, remains largely unknown.
Purpose of the Study:
- To evaluate the diagnostic performance of FFRCT in patients with suspected coronary artery disease (CAD), specifically assessing its accuracy in individuals with hypertension (HTN) and diabetes mellitus (DM).
- To determine if comorbidities like HTN and DM impact the diagnostic capabilities of FFRCT for identifying significant coronary stenosis.
Main Methods:
- A retrospective analysis was conducted on patients with suspected CAD, categorized into control, HTN, DM, and combined HTN+DM groups.
- Diagnostic performance of FFRCT was assessed per patient and per vessel, with invasive FFR ≤0.80 serving as the reference standard.
- Patients were further stratified by left ventricular mass index (LVMI) tertiles to explore the influence of cardiac remodeling.
Main Results:
- FFRCT demonstrated comparable diagnostic accuracy across patient groups: control (71.7%), HTN (79.3%), DM (75.0%), and HTN+DM (75.9%).
- No significant differences in the discrimination of ischemia by FFRCT were observed between the groups on both per-patient and per-vessel analyses.
- While diagnostic specificity declined in the highest LVMI tertile, FFRCT's ability to discriminate ischemia remained consistent across LVMI levels.
Conclusions:
- The diagnostic performance of FFRCT is not affected by the presence of hypertension (HTN) or diabetes mellitus (DM).
- FFRCT is a robust and reliable non-invasive tool for diagnosing stable coronary artery disease (CAD) across a wide patient spectrum, including those at high risk for microvascular disease.
Aims:
Fractional flow reserve (FFR) derived from coronary computed tomography (FFRCT) has high diagnostic performance in stable coronary artery disease (CAD). The diagnostic performance of FFRCT in patients with hypertension (HTN) and diabetes (DM), who are at risk of microvascular impairment, is not known.
Methods And Results:
We analysed the diagnostic performance of FFRCT, in patients (vessels) with DM (n = 16), HTN (n = 186), DM + HTN (n = 58) vs. controls (n = 107) with or with suspected CAD. Patients (vessels) were further divided according to left ventricular mass index (LVMI) tertiles. Reference standard was invasively measured FFR ≤0.80. Per-patient diagnostic accuracy (95% CI) in control patients was 71.7% (61.6-81.8) vs. 79.3 (74.0-85.0) (P = 0.12), 75.0% (47.6-92.7) (P = 0.52), and 75.9% (62.8-86.1) (P = 0.39) in patients with HTN, DM, and HTM + DM, respectively. There was no difference in discrimination of ischaemia by FFRCT between groups. On a per-vessel level, there was no significant difference in diagnostic performance or discrimination of ischaemia by FFRCT between groups. There was a decline in both per-patient and -vessel diagnostic specificity of FFRCT in the upper LVMI tertile when compared with lower tertiles; however, discrimination of ischaemia by FFRCT was unaltered across LVMI tertiles.
Conclusion:
The diagnostic performance of FFRCT is independent of the presence of HTN and DM. FFRCT is a robust method in a broad stable CAD population, including patients at high risk for microvascular disease.
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