Key result
Pressure recovery can mask upstream lesion severity despite preserved FFR and FFRct values.
Why the study?
Preserved FFR and FFRct values cannot always exclude the hemodynamic significance of upstream coronary lesions such as left main stenosis.
Case Report (n=1)
Preserved FFR and FFRct cannot always exclude the hemodynamic significance of upstream coronary lesions due to the phenomenon of pressure recovery.
FFRct may refine ischemia detection in equivocal LM stenosis on CTA; leaves open validation against invasive FFR in larger cohorts.
A 76-year-old male patient with dyspnea was referred on a suspicion of coronary artery disease. A coronary computed tomography angiography (CTA) revealed a distal left main (LM) stenosis and in the right (right coronary artery [RCA]), left circumflex (LCX) and left anterior descending (LAD) coronary arteries stenosis could not be excluded. CTA-derived fractional flow reserve (FFRct) was 0.75, 0.72, 0.74, 0.86, and 0.94 in the LM, LAD, LCX, ramus, and RCA, respectively. Invasive coronary angiography confirmed a stenosis in the LM and LAD. FFR was 0.73 and 0.85 in the LCX and ramus, respectively. The patient was referred for coronary artery bypass surgery. The FFR and FFRct values in the ramus demonstrate the phenomenon of pressure recovery. This case shows that preserved FFR and FFRct cannot always be used to exclude the hemodynamic significance of upstream coronary lesions.
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Jensen et al. (2019) conducted a case report in Coronary artery disease (n=1). Fractional flow reserve (FFR) and CTA-derived FFR (FFRct) was evaluated on Hemodynamic significance of upstream coronary lesions. Preserved FFR and FFRct values demonstrated pressure recovery, showing they cannot always be used to exclude the hemodynamic significance of upstream coronary lesions.
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