Key result
A large ramus artery was associated with a higher prevalence of distal FFR CT ≤0.80 (OR 7.0; 95% CI 1.2-40.1; p=0.03) in patients with no apparent coronary artery disease.
Why the study?
The ramus artery contributes to flow turbulence, but its relationship with FFR CT in patients without coronary artery disease remains unclear.
Does the presence of a ramus artery influence FFRCT values in patients without apparent coronary artery disease?
Observational (n=120)
Does the presence of a ramus artery influence FFRCT values in patients without apparent coronary artery disease?
The presence of a large ramus artery may cause a decline in FFRCT in patients without apparent coronary artery disease, potentially leading to false-positive physiological assessments.
Large ramus may artifactually lower FFRCT without CAD; leaves open clinical relevance pending validation.
Background The ramus artery contributes to the development of turbulence, which may influence computed tomography (CT) derived fractional flow reserve (FFR CT ) even without coronary artery disease (CAD). The relationship between ramus‐induced turbulence and FFR CT is unclear. Method and Results A total of 120 patients with <20% coronary stenosis assessed by both FFR CT and invasive coronary angiography were evaluated. The patients were divided into three groups: absent‐ramus ( n = 72), small‐ramus that could not be analyzed by FFR CT ( n = 18), and large‐ramus that could be analyzed by FFR CT ( n = 30). FFR CT measurements were performed at the proximal and distal segments of the left anterior descending (LAD), left circumflex (LCX), and ramus artery. With absent‐ramus and small‐absent ramus groups, FFR CT was measured at the distal end of the left main trunk at the same level for the proximal segments of the LAD and LCX. In absent‐ramus group, proximal FFR CT showed no significant differences between three vessels (LAD = .96 ± .02; MID = .97 ± .02; LCX = .97 ± .02). However, in small and large‐ramus groups, proximal FFR CT was significantly higher in the ramus artery than LAD and LCX (small‐ramus, LAD = .95 ± .03, Ramus = .97 ± .02, LCX = .95 ± .03; large‐ramus: LAD = .95 ± .03, Ramus = .98 ± .01; LCX = .96 ± .03; p < .05). A large ramus was associated with a higher prevalence of a distal FFR CT ≤.80 (odds ratio 7.0, 95% CI 1.2–40.1, p = .03). A proximal ramus diameter predicted distal FFR CT ≤.80 (cut‐off 2.1 mm, AUC .76, sensitivity 100%, specificity 52%, 95% CI .61–.90). Conclusions The presence of a large‐ramus artery may cause an FFR CT decline in no apparent CAD.
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Tsugu et al. (2023) conducted an observational in No apparent coronary artery disease (n=120). Large ramus artery vs. Absent or small ramus artery was evaluated on Distal FFR CT ≤0.80 (OR 7.0, 95% CI 1.2-40.1, p=0.03). A large ramus artery was associated with a higher prevalence of distal FFR CT ≤0.80 (OR 7.0; 95% CI 1.2-40.1; p=0.03) in patients with no apparent coronary artery disease.
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