Diffuse adverse coronary hemodynamics associated with type 2 diabetes: A CCTA-CFD phenotyping study

Patients with type 2 diabetes mellitus (T2DM) have a disproportionately high risk of atherosclerotic cardiovascular disease, which is not fully explained by the degree of coronary stenosis alone. In this retrospective study, patient-specific computational fluid dynamics (CFD) models were reconstructed from coronary computed tomography angiography (CCTA) data obtained from 53 individuals (26 non-T2DM and 27 T2DM). Time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT) were calculated to characterize the hemodynamic environment. Plaque composition and cardiac chamber dimensions were also analyzed. Results show patients with T2DM had significantly greater proportions of coronary surface area meeting the prespecified criteria for low TAWSS, high OSI, and high RRT than patients without T2DM (all P < 0.05) despite similar percent diameter stenosis. In plaque-level mixed-effects analyses accounting for within-patient clustering and clinical covariates, T2DM remained associated with lower TAWSS across all plaques (all P < 0.05). In plaque-type-stratified analyses, the most consistent adjusted differences were observed in non-calcified plaques. Longer diabetes duration was significantly associated with higher RRT (β = 0.0738, 95% CI: 0.0153 to 0.1324, P = 0.0135). These findings suggest that under standardized CCTA-CFD modeling assumptions, T2DM was associated with a greater patient-level burden of adverse simulated coronary hemodynamic regions. Plaque-level associations varied according to plaque composition and remained most evident in non-calcified plaques after multivariable adjustment. These findings suggest that CFD-derived hemodynamic assessment may provide information complementary to conventional anatomical measurements.