Kageyama Shigetaka, Tanaka Kaoru, Masuda Shinichiro, Kageyama Momoko, Garg Scot, Updegrove Adam, De Mey Johan, La Meir Mark, Onuma Yoshinobu, Serruys Patrick W
Department of Cardiology, National University of Ireland Galway, H91 TK33 Galway, Ireland.
Department of Radiology, University Hospital Brussels, 1090 Brussels, Belgium.
Biomedicines. 2023 Mar 15;11(3):913. doi: 10.3390/biomedicines11030913.
A 79-year-old male with chronic coronary syndrome with complex coronary artery disease was included in the first-in-man trial of surgical revascularization guided solely by coronary computed tomography angiography (CCTA) and fractional flow reserve derived from CCTA (FFR). In CCTA analysis, the patient had calcified three-vessel disease, with a global anatomical SYNTAX score of 27. In contrast, in the initial FFR, only the ramus intermediate stenosis was physiologically significant, with no other vessels having an FFR ≤ 0.80 (functional SYNTAX score of 2). Discordance between the results of the CCTA and FFR necessitated an in-depth analysis by using both invasive and non-invasive coronary angiography. Angiography-derived fractional flow reserve (FFR) confirmed that the stenosis in the proximal left anterior descending artery (LAD) was physiologically significant, while it remained functionally negative in the second assessment of FFR. Extensive calcification is the most plausible explanation for the underestimation of the stenosis of proximal LAD in CCTA-derived FFR technology.
一名患有慢性冠状动脉综合征及复杂冠状动脉疾病的79岁男性被纳入一项仅由冠状动脉计算机断层扫描血管造影（CCTA）及源自CCTA的血流储备分数（FFR）引导的外科血运重建人体首例试验。在CCTA分析中，该患者存在钙化的三支血管病变，整体解剖学SYNTAX评分为27分。相比之下，在初始FFR中，仅中间支狭窄具有生理学意义，其他血管的FFR均未≤0.80（功能性SYNTAX评分为2分）。CCTA与FFR结果之间的不一致使得有必要通过有创和无创冠状动脉造影进行深入分析。血管造影衍生的血流储备分数（FFR）证实左前降支近端（LAD）的狭窄具有生理学意义，而在第二次FFR评估中其功能仍为阴性。广泛钙化是CCTA衍生的FFR技术低估LAD近端狭窄的最合理原因。
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