Coronary flow impairment in asymptomatic patients with early stage type-2 diabetes: Detection by FFR(CT)

PURPOSE: To determine the occurrence of physiological significant coronary artery disease (CAD) by coronary CT angiography (CTA) derived fractional flow reserve (FFR(CT)) in asymptomatic patients with a new diagnosis (<1 year) of type-2 diabetes mellitus (T2DM). METHODS: FFR(CT)-analysis was performed from standard acquired coronary CTA data sets. The per-patient minimum distal FFR(CT)-value (d-FFR(CT)) in coronary vessels (diameter ⩾1.8 mm) was registered. The threshold for categorizing FFR(CT)-analysis as abnormal was a d-FFR(CT) ⩽0.75. Total plaque volume and volumes of calcified plaque, non-calcified plaque, and low-density non-calcified plaque (LD-NCP) were assessed by quantitative plaque analysis. RESULTS: Overall, 76 patients; age, mean (SD): 56 (11) years; males, n (%): 49(65), were studied. A total of 57% of patients had plaques. The d-FFR(CT) was ⩽0.75 in 12 (16%) patients. The d-FFR(CT), median (IQR), was 0.84 (0.79–0.87). Median (range) d-FFR(CT) in patients with d-FFR(CT) ⩽0.75 was 0.70 (0.6–0.74). Patients with d-FFR(CT)⩽0.75 versus d-FFR(CT) >0.75 had numerically higher plaque volumes for all plaques components, although only significant for the LD-NCP component. CONCLUSION: Every sixth asymptomatic patient with a new diagnosis of T2DM has hemodynamic significant CAD as evaluated by FFR(CT.) Flow impairment by FFR(CT) was associated with coronary plaque characteristics.