title: Diabetes does not impact the diagnostic performance of contrast-based fractional flow reserve: insights from the CONTRAST study.
abstract: 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.
  
  
  
  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.
  
  
  
  Of 763 subjects enrolled at 12 international centers, 219 (29%) had diabetes. The two groups were well-balanced 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).
  
  
  
  cFFR provides superior diagnostic performance compared with Pd/Pa or iFR for predicting FFR irrespective of diabetes (clinicaltrials.gov identifier NCT02184117).
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Frederico II, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gargiulo
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Frederico II, Naples, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Stabile
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Frederico II, Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ferrone
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Frederico II, Naples, Italy.|Cardiovascular Center, OLV Clinic, Aalst, Belgium.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
authors.affiliation: Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Frederik M
authors.initials: FM
authors.lastname: Zimmermann
authors.affiliation: Cardiovascular Center, OLV Clinic, Aalst, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Adjedj
authors.affiliation: West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland, UK.|British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Hennigan
authors.affiliation: Cardiovascular Research Foundation (CRF), New York, NY, USA.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Matsumura
authors.affiliation: Division of Cardiology, Department of Medicine, Weatherhead PET Center, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA.
authors.forename: Nils P
authors.initials: NP
authors.lastname: Johnson
authors.affiliation: Stanford University Medical Center, Stanford, USA.|The Palo Alto VA Health Care Systems, Palo Alto, CA, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.affiliation: Cardiovascular Research Foundation (CRF), New York, NY, USA.|Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Jeremias
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Frederico II, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Frederico II, Naples, Italy. espogiov@unina.it.|Division of Cardiology-Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy. espogiov@unina.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D003287:Contrast Media
keywords: Adenosine; Contrast medium; Coronary lesion; Diabetes; Fractional flow reserve; Hyperemia; Instantaneous wave-free ratio; Resting metrics