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Noninvasive Fractional Flow Reserve for the Diagnosis of Lesion-specific Ischemia: A Case Example.

ABSTRACT: A physically active 52-year-old male with atypical chest pain was referred to our department. A coronary computed tomography angiography (CCTA) showed a stenotic plaque in the mid left anterior descending coronary artery (LAD). A rest-stress Rubidium-82 myocardial perfusion was normal. One year later the patient sustained a cardiac arrest and percutaneous coronary intervention of the mid-LAD was successfully performed. The original CCTA data were submitted for noninvasive determination of fractional flow reserve (FFRCT) revealing an ischemia-producing lesion in the mid-LAD. This case demonstrates the inherent limitations of assessing lesion-specific ischemia. FFRCT shows promise as a new method for future selection of patients for coronary angiography.

SUBMITTER: Jensen JM

PROVIDER: S-EPMC4322374 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Noninvasive Fractional Flow Reserve for the Diagnosis of Lesion-specific Ischemia: A Case Example.

Jensen Jesper Møller JM Gormsen Lars Christian LC Gormsen Lars Christian LC Mølgaard Henning H Nørgaard Bjarne Linde BL

Journal of clinical imaging science 20150130

A physically active 52-year-old male with atypical chest pain was referred to our department. A coronary computed tomography angiography (CCTA) showed a stenotic plaque in the mid left anterior descending coronary artery (LAD). A rest-stress Rubidium-82 myocardial perfusion was normal. One year later the patient sustained a cardiac arrest and percutaneous coronary intervention of the mid-LAD was successfully performed. The original CCTA data were submitted for noninvasive determination of fracti ...[more]

PMID: 25806138

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Project description:Purpose of reviewAccumulating evidence exists for the value of coronary physiology for clinical decision-making in ischemic heart disease (IHD). The most frequently used pressure-derived index to assess stenosis severity, the fractional flow reserve (FFR), has long been considered the gold standard for this purpose, despite the fact that the FFR assesses solely epicardial stenosis severity and aims to estimate coronary flow impairment in the coronary circulation. The coronary flow reserve (CFR) directly assesses coronary blood flow in the coronary circulation, including both the epicardial coronary artery and the coronary microvasculature, but is nowadays less established than FFR. It is now recognized that both tools may provide insight into the pathophysiological substrate of ischemic heart disease, and that particularly combined FFR and CFR measurements provide a comprehensive insight into the multilevel involvement of IHD. This review discusses the diagnostic and prognostic characteristics, as well as future implications of combined assessment of FFR and CFR pressure and flow measurements as parameters for inducible ischemia.Recent findingsFFR and CFR disagree in up to 40% of all cases, giving rise to fundamental questions regarding the role of FFR in contemporary ischemic heart disease management, and implying a renewed approach in clinical management of these patients using combined coronary pressure and flow measurement to allow appropriate identification of patients at risk for cardiovascular events. This review emphasizes the value of comprehensive coronary physiology measurements in assessing the pathophysiological substrate of IHD, and the importance of acknowledging the broad spectrum of epicardial and microcirculatory involvement in IHD. Increasing interest and large clinical trials are expected to further strengthen the potential of advanced coronary physiology in interventional cardiology, consequently inducing reconsideration of current clinical guidelines.

Dataset Information

Noninvasive Fractional Flow Reserve for the Diagnosis of Lesion-specific Ischemia: A Case Example.

Publications

Noninvasive Fractional Flow Reserve for the Diagnosis of Lesion-specific Ischemia: A Case Example.

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