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Impact of Left Ventricular Outflow Tract Obstruction on Coronary Physiological Assessment

Yoshihiro Harano1, Yoshiaki Kawase1, Takayuki Warisawa2

  • 1Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|March 2, 2023
PubMed

Insights

Hypertrophic obstructive cardiomyopathy with coronary lesions requires careful physiological assessment. Left ventricular outflow tract obstruction dynamically alters fractional flow reserve (FFR) and resting full-cycle ratio (RFR) values.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology

Background:

  • Hypertrophic cardiomyopathy (HCM) can coexist with coronary artery disease (CAD).
  • Coronary physiological assessment is crucial in such cases, but the impact of left ventricular outflow tract (LVOT) obstruction remains unclear.

Observation:

  • A case of hypertrophic obstructive cardiomyopathy (HOCM) with a moderate coronary lesion was studied.
  • Dynamic changes in physiological values were observed during pharmacological intervention to reduce LVOT pressure gradient.

Findings:

  • Fractional flow reserve (FFR) decreased from 0.83 to 0.79.
  • Resting full-cycle ratio (RFR) increased from 0.73 to 0.91.
  • These opposing changes in FFR and RFR occurred after administering propranolol and cibenzoline.

Implications:

  • LVOT obstruction significantly impacts coronary physiological assessment in HOCM patients.
  • Interpreting FFR and RFR requires careful consideration of concomitant cardiovascular conditions.
  • Clinicians must be aware of these dynamic changes for accurate diagnosis and treatment planning.

Keywords:
Case reportCoronary artery diseaseCoronary physiologyFractional flow reserveLeft ventricular outflow tract obstructionResting full-cycle ratio

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