Background: Data regarding the performance of computational fractional flow reserve in patients with diabetes mellitus (DM) remain scarce. This study sought to explore the impact of DM on quantitative flow ratio (QFR) and its association with intravascular ultrasound (IVUS)-derived anatomical references.Methods and Results: IVUS and QFR were retrospectively analyzed in 237 non-diabetic and 93 diabetic patients with 250 and 102 intermediate lesions, respectively. Diabetics were further categorized based on adequate (HbA1c <7.0%: 47 patients with 53 lesions) or poor (HbA1c ≥7.0%: 46 patients with 49 lesions) glycemic control. Lesions with QFR ≤0.8 or minimum lumen area (MLA) ≤4.0 mm 2 and plaque burden (PB, %) ≥70 were considered functionally or anatomically significant, respectively. PB increased, and MLA decreased stepwise across non-diabetics, diabetics with adequate glycemic control and those with poor glycemic control. In contrast, QFR was similar among the 3 groups. PB correlated significantly with the QFR for lesions in non-diabetics, but not for lesions in diabetics. DM was independently correlated with the functionally non-significant lesions (QFR >0.8) with high-risk IVUS features (MLA ≤4.0 mm 2 and PB ≥70; OR 2.053, 95% CI: 1.137-3.707, P=0.017). When considering the effect of glycemic control, HbA1c was an independent predictor of anatomical-functional discordance (OR 1.347, 95% CI: 1.089-1.667, P=0.006).Conclusions: Anatomical-functional discordance of intermediate coronary lesions assessed by IVUS and QFR is exacerbated in patients with diabetes, especially when glycemia is poorly controlled.

Aims The great value concealed in the sequence of coronary angiography frames is not discovered in the world. We discovered and demonstrated the Sequence Value concealed in the coronary angiography and proposed DZL (Disarranged Zone Learning) to realize the sequence value in functional evaluation of coronary artery disease. Furthermore, we automated the DZL using a deep learning model to release huge medical resources. Methods and Results We gave a novel definition of TIMI flow grade using the term temporal and spatial coupling tightness (TSCT) of the antegrade contrast agent. We used the TSCT to model the myocardial ischemia in a functional perspective and used the PCI conduction after CAG as the outcome event of myocardial ischemia. We proposed a novel method (Disarranged Zone Learning) to measure TSCT and we designed an experiment to validate its effectiveness. We further automated the novel method using an unsupervised deep learning model. The prediction accuracy of the model was applied as a proxy of myocardial ischemia. We further proposed Difference DZL to quantify the functional capability of any specific vessel segment. DZL overall AUC reaches 0.92. DZL automation reveals an AUC of 0.84 (95%CI, 0.81-0.87). Conclusion We unprecedentedly discovered the Sequence Value concealed in coronary angiography. We then proposed a novel method termed DZL to functionally evaluate the coronary artery in a non-invasive, real-time and adaptive manner.

Objectives: Minimally invasive direct coronary artery bypass (MIDCAB) with the left internal thoracic artery (LITA) provides excellent long-term results for isolated left anterior descending coronary artery (LAD) disease. We tried to evaluate the impact of the previous percutaneous coronary intervention (p-PCI) for LAD on the clinical outcomes of MIDCAB in this study.Methods: A total of 197 patients with isolated LAD disease underwent MIDCAB in our center from February 2009 to May 2020. 51 patients had the p-PCI for LAD and 146 patients did not. The primary outcome was the major adverse cardiovascular event (MACE).Results: The incidences of the perioperative outcomes were comparable between the two groups (p > .05). The median follow-up time was 48.0 months (interquartile range, 25.9-85.5 months). The incidences of MACE (p < .001) and myocardial infarction or recurrent angina (p < .001) were significantly higher in the p-PCI group than those in the non-PCI group. The estimated 5-year freedom from MACE in the p-PCI group was significantly lower (56.1%, 95% confidence interval [CI]: 41.2%-71.0% vs. 83.4%, 95% CI: 76.7%-90.1%, p < .001). The previous LAD-PCI (hazard ratio [HR]: 2.664, 95% CI:1.471-4.822, p = .001) and the history of peripheral arterial disease (HR: 3.145, 95% CI:1.085-9.113, p = .035) were the independent predictors of MACE. The p-PCI group had a higher diseased graft rate than the non-PCI group (10.9% vs. 2.3%, p = .046). Conclusions:The previous LAD-PCI may deteriorate the outcomes of MIDCAB in patients with isolated LAD disease.