When Intracoronary Anatomy is Superior to Physiology

Figures

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  Fig. 1.. Anatomic dependence of non-IRA assessment in acute coronary syndromes with zones of perfusion and infarcted myocardium. Overlapping infarcted microvascular bed represents a source of error in non-IRA FFR. Abbreviations: FFR, fractional flow reserve; LAD, left anterior descending coronary artery; LCx, left circumflex coronary artery; LM, left main coronary artery; IRA, infarct related artery; non-IRA, non-infarct related artery.

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  Fig. 2.. FFR of left main stenosis with downstream disease. FFR is reliable in isolated LM disease and distal LM disease with ostial involvement when FFR is measured across both LAD and LCx. LM FFR may be falsely negative when FFR of LAD+LM together fall below 0.60 or when significant downstream disease is present but FFR is measured across only the LM lesion. Abbreviations: FFR, fractional flow reserve; LAD, left anterior descending coronary artery; LCx, left circumflex coronary artery; LM, left main coronary artery.

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  Fig. 3.. Effects of simulated distal obstruction on LM FFR. (Top) Coronary pressure recorded from the distal LAD as a balloon is inflated simulating variable downstream LAD disease and the effect on FFRepi. (Bottom) Coronary pressure recorded simultaneously as the top panel but from the LCx (representing FFRtrue and FFRapp) as the balloon is inflated in the LAD. Green line represents distal coronary pressure (Pd), the red line represents aortic pressure (Pa), and the yellow line is the calculated FFR value. Abbreviations: FFR, fractional flow reserve; FFRapp, apparent FFR; FFRepi, epicardial FFR; FFRtrue, true FFR; LAD, left anterior descending artery; LCx, left circumflex coronary artery; LM, left main coronary artery. Taken from Fearon et al. JACC Cardiovasc Interv. 2015 Mar; 8(3): 398-403 available under open access.

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  Fig. 4.. Multiple sources of flow in the assessment of saphenous vein grafts. FFR measured distal to the SVG attachment site reflects flow from the SVG graft, the native vessel and any collateral circulation that has formed and may be misleading in assessing the significance of SVG lesions. Abbreviations: FFR, fractional flow reserve; LAD, left anterior descending coronary artery; RCA, right coronary artery.