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Pressure Recovery in the Left Main Stenosis
Jesper Møller Jensen1, Hans Erik Bøtker1, Niels Peter Rønnow Sand2
1Department of Cardiology, Aarhus University Hospital, Aarhus.
Journal of Clinical Imaging Science
|September 21, 2019
Summary
Fractional flow reserve (FFR) and CT-derived FFR (FFRct) may not always exclude significant coronary artery disease, even with preserved values. Pressure recovery in specific vessels can mask upstream lesions.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Diagnostic Accuracy
Background:
- Coronary artery disease (CAD) diagnosis often relies on assessing the hemodynamic significance of coronary stenoses.
- Fractional flow reserve (FFR) is a gold standard, while CT-derived FFR (FFRct) offers a non-invasive alternative.
- The interpretation of FFR and FFRct can be complex, particularly in cases with multiple lesions or specific anatomical variations.
Observation:
- A 76-year-old male presented with dyspnea, suspected coronary artery disease.
- Coronary computed tomography angiography (CTA) revealed distal left main (LM) stenosis and indeterminate stenoses in the right (RCA), left circumflex (LCX), and left anterior descending (LAD) coronary arteries.
- CTA-derived fractional flow reserve (FFRct) values were 0.75 (LM), 0.72 (LAD), 0.74 (LCX), 0.86 (ramus), and 0.94 (RCA).
Findings:
- Invasive coronary angiography confirmed LM and LAD stenosis.
- Invasive FFR measurements were 0.73 (LCX) and 0.85 (ramus).
- The preserved FFR and FFRct values in the ramus, despite upstream LM stenosis, illustrate the phenomenon of pressure recovery.
Implications:
- This case highlights that normal or preserved FFR/FFRct values cannot definitively exclude hemodynamically significant upstream coronary lesions.
- Pressure recovery can lead to underestimation of stenosis severity in certain coronary segments.
- Clinical decisions should integrate imaging findings, invasive measurements, and anatomical context to accurately assess CAD significance.
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