Noninvasive Fractional Flow Reserve for the Diagnosis of Lesion-specific Ischemia: A Case Example

A physically active 52-year-old male with atypical chest pain was referred to our department. A coronary computed tomography angiography (CCTA) showed a stenotic plaque in the mid left anterior descending coronary artery (LAD). A rest–stress Rubidium-82 myocardial perfusion was normal. One year later the patient sustained a cardiac arrest and percutaneous coronary intervention of the mid-LAD was successfully performed. The original CCTA data were submitted for noninvasive determination of fractional flow reserve (FFR(CT)) revealing an ischemia-producing lesion in the mid-LAD. This case demonstrates the inherent limitations of assessing lesion-specific ischemia. FFR(CT) shows promise as a new method for future selection of patients for coronary angiography.