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Updated: Apr 9, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
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.
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.
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