title: Fractional flow reserve derived from coronary computed tomography angiography: diagnostic performance in hypertensive and diabetic patients.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Eftekhari
authors.affiliation: Weill Cornell Medical College, Dalio Institute of Cardiovascular Imagaing, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: James
authors.initials: J
authors.lastname: Min
authors.affiliation: Department of Cardiology, University of Erlangen, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Department of Cardiology, University of Erlangen, Erlangen, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Marwan
authors.affiliation: Department of Medicine, Los Angeles Biomedical Research Center, Torrance, CA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: Division of Cardiology, Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
authors.forename: Sara
authors.initials: S
authors.lastname: Gaur
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
authors.forename: Jesper Møller
authors.initials: JM
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, University of Erlangen, Erlangen, Germany.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Ko
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
authors.forename: Evald Høj
authors.initials: EH
authors.lastname: Christiansen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Kaltoft
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
authors.forename: Bjarne Linde
authors.initials: BL
authors.lastname: Nørgaard
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: angiography; coronary computed tomography; diabetes; fractional flow reserve; hypertension; microcirculation