Comparison of Diagnostic Performance of Quantitative Flow Ratio in Patients With Versus Without Diabetes Mellitus

• Published in: The American journal of cardiology 2019-05, Vol.123 (10), p.1722-1728
• Main Authors: Smit, Jeff M., El Mahdiui, Mohammed, van Rosendael, Alexander R., Jukema, J. Wouter, Koning, Gerhard, Reiber, Johan H.C., Bax, Jeroen J., Scholte, Arthur J.
• Format: Article
• Language: English
• Subjects: Accuracy; Aged; Angiography; Arteries; Blood Flow Velocity - physiology; Blood vessels; Coronary Angiography - methods; Coronary artery; Coronary vessels; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Diabetes; Diabetes Mellitus; Diagnostic software; Diagnostic systems; Female; Flow velocity; Fluid dynamics; Fractional Flow Reserve, Myocardial - physiology; Heart attacks; Humans; Hyperemia; Imaging, Three-Dimensional - methods; Male; Medical diagnosis; Medical imaging; Microvasculature; Non-ST Elevated Myocardial Infarction - complications; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - physiopathology; Patients; Predictive Value of Tests; Retrospective Studies; ROC Curve; Sensitivity analysis; Software packages; Stenosis; Stents; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2019.02.035

Quantitative flow ratio (QFR) is a novel technique to calculate fractional flow reserve (FFR), without hyperemia induction or a pressure wire, and has not yet been validated in patients with diabetes mellitus (DM), who are at increased risk of coronary microvascular dysfunction. The purpose of our study was to compare the diagnostic performance of QFR in diabetic and nondiabetic patients. Patients who underwent invasive coronary angiography and subsequent invasive FFR measurement within 6 months were included. QFR was determined in all coronary arteries in which invasive FFR was performed, using a dedicated software package. Diagnostic accuracy and the area under the receiver-operating characteristic curve (AUC) were determined for QFR, using an invasive FFR cut-off value of ≤0.80 as the reference standard. In total, 320 coronary arteries from 66 (25%) diabetic and 193 (75%) nondiabetic patients were analyzed. On a vessel-based analysis, diagnostic accuracy, sensitivity, and specificity showed no significant difference between diabetic and nondiabetic patients: 88% versus 85% (p = 0.47), 71% versus 69% (p = 0.72), and 95% versus 91% (p = 0.24). Moreover, the AUC was not significantly different between patients with and without DM, 0.91 versus 0.93 (p = 0.74). The per-vessel AUC was significantly higher for QFR compared with percent diameter stenosis in both diabetic and nondiabetic patients, 0.91 versus 0.76 (p