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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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A "normal" invasive coronary angiogram may not be normal

Bjarne L Nørgaard1, Nicolaj C Hansson1, Evald H Christiansen1

  • 1Department of Cardiology, Aarhus University Hospital Skejby, Skejby, Aarhus N, Aarhus DK-8200, Denmark.

Journal of Cardiovascular Computed Tomography
|June 20, 2015
PubMed

Insights

A normal invasive coronary angiogram may not rule out significant coronary artery disease. Two patients showed vessel-specific ischemia despite near-normal angiograms, confirmed by fractional flow reserve measurements.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Invasive coronary angiography is the gold standard for diagnosing coronary artery disease.
  • A normal or near-normal angiogram is typically considered definitive for excluding significant coronary artery disease.

Observation:

  • Two patients presented with near-normal invasive coronary angiograms.
  • Noninvasive testing suggested vessel-specific ischemia in both cases.

Findings:

  • Fractional flow reserve (FFR) measurements confirmed significant ischemia in the coronary arteries.
  • This indicates that near-normal angiograms can mask underlying hemodynamically significant disease.

Implications:

  • Clinical practice guidelines may need re-evaluation regarding the interpretation of near-normal coronary angiograms.
  • Fractional flow reserve is crucial for accurately assessing ischemia in select patients.
  • This highlights the importance of integrating noninvasive and invasive data for comprehensive cardiovascular assessment.

Keywords:
Computed tomographyCoronary angiographyCoronary artery diseaseCoronary plaqueFractional flow reserve

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