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Impact of Plaque Components on Fractional Flow Reserve-Derived Computed Tomography in Severe Coronary Stenosis
Toshimitsu Tsugu1, Kaoru Tanaka1, Yuji Nagatomo2
1Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Insights
Fractional flow reserve from CT can accurately assess coronary stenosis. However, this case shows severe stenosis may not significantly alter CT-derived fractional flow reserve, influenced by factors like large branches.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Computational Fluid Dynamics
Background:
- Fractional flow reserve derived from computed tomography (CT-FFR) is a valuable non-invasive tool for diagnosing coronary artery disease.
- Severe coronary stenosis typically leads to a significant drop in CT-FFR values across the lesion.
- Accurate CT-FFR assessment is crucial for guiding revascularization decisions.
Observation:
- A case study involving a 75-year-old male with 85% diameter stenosis in the distal right coronary artery is presented.
- Despite severe stenosis confirmed by both CT angiography and invasive angiography, CT-FFR showed minimal change (0.97 to 0.95).
- This contrasts with typical CT-FFR behavior in severe coronary stenosis.
Findings:
- The study highlights a potential discrepancy between anatomical stenosis severity and CT-FFR measurements.
- Factors such as a large acute marginal branch and lower plaque components in the stenotic lesion were identified as potential confounders.
- These anatomical variations may influence the hemodynamic significance of coronary stenosis as assessed by CT-FFR.
Implications:
- The findings suggest that CT-FFR interpretation requires careful consideration of complex coronary anatomy and plaque characteristics.
- Further research is needed to refine CT-FFR algorithms to account for such anatomical variations.
- This could improve the diagnostic accuracy and clinical utility of non-invasive CT-FFR in complex coronary artery disease cases.
Abstract:
Fractional flow reserve derived from computed tomography decreases across severe coronary stenosis. The diagnostic accuracy of fractional flow reserve-derived computed tomography is high for severe coronary stenosis. In this report, we present a case of no significant fractional flow reserve-derived computed tomography changes even in severe coronary stenosis. A 75-year-old man showed severe stenosis (85% diameter stenosis) in the distal segment of the right coronary artery on both computed tomography angiography and invasive coronary angiography. However, fractional flow reserve-derived from computed tomography showed no significant changes from the proximal (0.97) to the distal (0.95) segments despite the presence of severe stenotic lesion. This patient had different features including the presence of a large acute marginal branch and significantly lower plaque components in the stenotic lesion compared with another patient who had coronary stenosis in the same segment. A large bifurcation branch and/or proportion of plaque components can affect fractional flow reserve-derived from computed tomography hemodynamics.
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