Diabetes does not impact the diagnostic performance of contrast-based fractional flow reserve: insights from the CONTRAST study

Gargiulo, G. et al. (2017) Diabetes does not impact the diagnostic performance of contrast-based fractional flow reserve: insights from the CONTRAST study. Cardiovascular Diabetology, 16, 7. (doi: 10.1186/s12933-016-0494-2) (PMID:28086778) (PMCID:PMC5237130)

Abstract

Background: Adenosine-free coronary pressure wire metrics have been proposed to test the functional significance of coronary artery lesions, but it is unexplored whether their diagnostic performance might be altered in patients with diabetes. Methods: We performed a post-hoc analysis of the CONTRAST study, which prospectively enrolled an international cohort of patients undergoing routine fractional flow reserve (FFR) assessment for standard indications. Paired, repeated measurements of all physiology metrics (Pd/Pa, iFR, contrast-based FFR, and FFR) were made. A central core laboratory analyzed blinded pressure tracings in a standardized fashion. Results: Of 763 subjects enrolled at 12 international centers, 219 (29%) had diabetes. The two groups were wellbalanced for age, clinical presentation (stable or unstable), coronary vessel studied, volume and type of intracoronary contrast, and volume of intracoronary adenosine. A binary threshold of cFFR ≤ 0.83 produced an accuracy superior to both Pd/Pa and iFR when compared with FFR ≤ 0.80 in the absence of significant interaction with diabetes status; indeed, accuracy in subgroups of patients with or without diabetes was similar for cFFR (86.7 vs 85.4% respectively; p = 0.76), iFR (84.2 vs 80.0%, p = 0.29) and Pd/Pa (81.3 vs 78.9%, p = 0.55). There was no significant heterogeneity between patients with or without diabetes in terms of sensitivity and specificity of all metrics. The area under the receiver operating characteristic (ROC) curve was largest for cFFR compared with Pd/Pa and iFR which were equivalent (cFFR 0.961 and 0.928; Pd/Pa 0.916 and 0.870; iFR 0.911 and 0.861 in diabetic and non-diabetic patients respectively). Conclusions: cFFR provides superior diagnostic performance compared with Pd/Pa or iFR for predicting FFR irrespective of diabetes (clinicaltrials.gov identifier NCT02184117).

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Hennigan, Dr Barry
• Authors: Gargiulo, G., Stabile, E., Ferrone, M., Barbato, E., Zimmermann, F. M., Adjedj, J., Hennigan, B., Matsumura, M., Johnson, N. P., Fearon, W. F., Jeremias, A., Trimarco, B., and Esposito, G.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Cardiovascular Diabetology
• Publisher: BioMed Central
• ISSN: 1475-2840
• ISSN (Online): 1475-2840
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Cardiovascular Diabetology 16: 7
• Publisher Policy: Reproduced under a Creative Commons License