Pressure Recovery in the Left Main Stenosis

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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
PubMed

Insights

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.

Keywords:
Coronary artery diseaseCoronary computed tomography angiographyFractional flow reserve

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