HKUMed reveals combining novel angiography FFR imaging technology with glucose lowering drug effectively protects the heart of diabetic patients

A recent study led by the Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine of the University of Hong Kong (HKUMed), in collaboration with the University of Hong Kong-Shenzhen Hospital, has demonstrated that combining an innovative coronary imaging technology known as the caFFR system, with diabetes drug SGLT2 inhibitors can significantly reduce the risks of major adverse cardiovascular events (MACE), heart failure and death among patients with type 2 diabetes mellitus (T2DM) and coronary artery disease. This dual-pronged strategy provides a precise measurement of coronary blood flow while lowering glucose levels, offering an effective approach to treating exceptionally high-risk patients. The findings were published in the Diabetes and Metabolism Journal link to the publication.

caFFR images access coronary blood flow

Patients with T2DM commonly develop more complex and severe forms of coronary artery disease, often involving multiple narrowed or blocked arteries. This complexity makes it challenging for cardiologists to achieve 'complete revascularisation', where all significantly blocked arteries are fully opened to restore blood flow. Without detailed functional assessment, some blockages that appear mild on imaging but are functionally important may be overlooked. If these high-risk blockages are not identified, patients may be at risk of 'incomplete revascularisation' and experience persistent ischaemia despite treatment, ultimately increasing their long-term cardiac risk.

To address this challenge, Professor Yiu Kai-hang, Clinical Professor in the Department of Medicine, School of Clinical Medicine, HKUMed, led a research team to evaluate the use of the caFFR system, an innovative imaging technology that allows accurate measurement of coronary blood flow from standard angiogram images. This technique enables cardiologists to identify which arterial blockages are truly responsible for ischaemia, thus supporting more precise decision-making and the development of more effective interventional treatment strategies for high-risk patients.

Professor Yiu Kai-hang explains that the functional assessment using the caFFR system is crucial for achieving optimal revascularisation in diabetic patients. SGLT2 inhibitors offer robust cardiovascular protection and significantly improve survival outcomes, even in cases of incomplete revascularisation.

SGLT2 inhibitors provide powerful cardiac protection

The study analysed data from 671 patients with both T2DM and coronary artery disease who underwent angiogram imaging in public hospitals between 2014 and 2016. While complete revascularisation was achieved in some patients, many still had residual stenosis after undergoing the revascularisation procedure due to diffuse and complex diabetic atherosclerosis. Remarkably, for those with incomplete revascularisation, the use of SGLT2 inhibitors provided powerful vascular protecton. The three-year incidence of MACE was markedly reduced from 17.8% to 8.3%, while all-cause mortality dropped sharply from 16.3% to 6.3% over the same period.

HKUMed reveals that combining novel caFFR imaging technology with glucose lowering drug effectively protects the heart of diabetic patients. In the photo are Professor Yiu Kai-hang (left), who led the research, and his team member Dr Xuan Haochen.

'Our findings show that functional assessment using the caFFR system allows clinicians to accurately identify blockages that truly cause ischemia, which is crucial for achieving optimal revascularisation in diabetic patients,' said Professor Yiu Kai-hang. 'Moreover, even when complete revascularisation cannot be achieved, SGLT2 inhibitors offer robust cardiovascular protection, significantly improving survival outcomes. This dual approach represents a major step forward in managing heart disease among individuals with diabetes.'

The study underscores the complementary roles of precision interventional imaging and pharmacological therapy in improving outcomes for diabetic patients with coronary artery disease. By integrating caFFR-guided vascular reconstruction procedures with SGLT2 inhibitor therapy, clinicians can better tailor treatment to each patient's needs, offering both anatomical and metabolic protection for the heart.

Professor Yiu added, 'This study has importance implications for clinical practice. It demonstrates that even when structural risks in the blood vessels may persist, SGLT2 inhibitors provide a vital safety net, reducing future cardiovascular risks. The findings reinforce HKUMed's ongoing commitment to translating clinical innovation into better patient care.'

About the research team

The study was led by Professor Yiu Kai-hang, Clinical Professor, Department of Medicine, School of Clinical Medicine, HKUMed, and conducted in collaboration with the University of Hong Kong–Shenzhen Hospital.

A research team from the Department of Orthopaedics and Traumatology, School of Clinical Medicine, LKS Faculty of Medicine of the University of Hong Kong (HKUMed), has demonstrated that robotic total hip replacement has a lower reoperation rate than the conventional technique. The study found a 90-day reoperation rate of only 0.6% with robotic procedures as compared to 2.5% with conventional procedures. Robotic procedures thus promise long-term benefits for patients, enabling them to regain mobility and return to normal life.

End-stage hip arthritis causes severe groin pain, joint stiffness and functional deficit, including impairment in walking, sitting and standing. While total hip replacement is a common operation, complications can occur and may lead to reoperation and prolonged recovery times.

Precision in robotic arm assisted total hip replacement

Compared to conventional technique, robotic hip replacement utilises three-dimensional computed tomography scans for precise preoperative planning of both acetabular and femoral components. During surgery, acetabular bone preparation and implant positioning are carried out under robotic arm guidance, allowing for precise control over bone removal and cup placement.

Dr Henry Fu Chun-him, Clinical Associate Professor and Chief of the Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, School of Clinical Medicine, HKUMed, said, ‘The robotic arm allows the direction and depth of the acetabular cup placement to be executed in accordance with preoperative planning, achieving angular precision down to 2 degrees and depth accuracy within 2mm.’

Six-year local data confirms safety advantages of robotic hip replacement

The research team reviewed the results of 553 primary total hip replacement surgeries performed in Queen Mary Hospital and the Duchess of Kent Children's Hospital at Sandy Bay Joint Replacement Centre between 1 January 2019 and 31 December 2024. These included 311 robotic total hip replacements and 242 conventional total hip replacements. The rate of reoperation within 30 and 90 days after surgery was lower for the robotic total hip replacement.

Dr Fu added, ‘Early reoperations after total hip replacement are devastating. With robotics, the rate of reoperation at 90 days is only 0.6%.’ In cases requiring reoperation in the robotic group, all procedures were done in a closed manner without the need for surgical reopening. In contrast, the conventional group had a 2.5% reoperation rate due to periprosthetic fractures and wound infections, requiring surgical reopening and resulting in prolonged recovery times.

While robotic procedures were associated with an overall increase in operative time of 14 minutes, the team observed a clear learning-curve effect, with surgical times progressively approaching those of conventional manual procedures.

Growing utilisation of robotic surgery

HKUMed Department of Orthopaedics and Traumatology was the first in Hong Kong to utilise robotic arm technology for joint replacement surgery in public hospitals, beginning in January 2019.

Dr Amy Cheung Yim-ling, Honorary Clinical Assistant Professor and Deputy Division Chief of the Division of Joint Replacement Surgery of the same department, said, ‘The utilisation of robotics for total hip replacement in Queen Mary Hospital and the Duchess of Kent Children' s Hospital at Sandy Bay has risen steadily from 32% in 2019 to 85% in 2025. In the local public sector, robotic procedures now account for 49% of total hip replacement surgeries.’

HKUMed study demonstrates that robotic total hip replacement has a lower reoperation rate than the conventional technique. The research team members include Dr Henry Fu Chun-him (right) and Dr Amy Cheung Yim-ling.

HKUMed study demonstrates that robotic total hip replacement has a lower reoperation rate than the conventional technique. The research team members include Dr Henry Fu Chun-him (right) and Dr Amy Cheung Yim-ling.

Dr Henry Fu Chun-him (right) highlights that increased experience has progressively shortened the surgery time of robotic total hip replacement. Ms Lai (middle), a patient who has recovered after the robotic surgery, shares that the robotic surgery helps her regain mobility and return to normal life.