What question did this study set out to answer?

To assess the hemodynamic significance of a right coronary artery anomaly using both FFR and iFR during dobutamine testing.

March 28, 2026Open Access

An 11-Year-Old Athlete With Dynamic Stenosis of Coronary Artery Anomaly With Normal FFR-Dobutamine But Abnormal iFR-Dobutamine

Key Result

Dynamic stenosis of an anomalous right coronary artery in an 11-year-old athlete resulted in an abnormal iFR-dobutamine despite a normal FFR-dobutamine.

Key Points

To assess the hemodynamic significance of a right coronary artery anomaly using both FFR and iFR during dobutamine testing.
Performed a dobutamine stress test to evaluate hemodynamic responses in the patient.
Examined both fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) measurements during the assessment.
FFR during dobutamine challenge was normal, suggesting no significant obstruction.
iFR measurement indicated abnormal results, pointing to stress-induced ischemia despite normal FFR.

Structured PICO

Does iFR-dobutamine detect stress-induced ischemia differently than FFR-dobutamine in a pediatric patient with R-AAOCA?

Population

11-year-old athlete with anomalous aortic origin of a right coronary artery (R-AAOCA) causing dynamic stenosis of the intramural course (n=1)

Intervention

Instantaneous wave-free ratio (iFR) during dobutamine challenge

Comparator

Fractional flow reserve during dobutamine challenge (FFRDobutamine)

Outcome

Hemodynamic assessment of stress-induced ischemiasurrogate

This case highlights a specific scenario in anomalous coronary arteries where iFR-dobutamine may detect ischemia despite a normal FFR-dobutamine reference standard.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Anomalous aortic origin of a right coronary artery (R-AAOCA) can cause stress-induced ischemia owing to dynamic stenosis of the intramural course. While fractional flow reserve during dobutamine challenge (FFRDobutamine) is the reference standard for hemodynamic assessment, specific scenarios favoring instantaneous wave-free ratio (iFR) over FFR remain unclear.