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20 June 2018 : Case report  Russian Federation

One-Dimensional Mathematical Model-Based Automated Assessment of Fractional Flow Reserve in a Patient with Silent Myocardial Ischemia

Unusual setting of medical care

Daria Gognieva1ABCDEF*, Timur Gamilov12D, Roman Pryamonosov2D, Vladimir Betelin3AG, Sergey K. Ternovoy4AG, Natalya S. Serova4B, Sergej Abugov5BC, Dmitry Shchekochikhin1A, Yulia Mitina6E, Houssem El-Manaa1B, Philippe Kopylov1AG

DOI: 10.12659/AJCR.908449

Am J Case Rep 2018; 19:724-728

Abstract

BACKGROUND: Noninvasive assessment of the fractional flow reserve (FFR) in patients with coronary artery disease plays an important role in determining the need for revascularization. It is particularly relevant for patients with a borderline stenoses and painless myocardial ischemia. Our article describes the first clinical experience in the Russian Federation of using an automated method of noninvasive assessment of the fractional flow reserve (FFRct) with a one-dimensional (1-D) mathematical model in a patient with painless myocardial ischemia.

CASE REPORT: A 58-year-old male patient who underwent stent implantation in the left circumflex coronary artery (LCX) due to an acute non-ST-elevation posterior myocardial infarction had borderline stenoses of the left anterior descending artery (LAD). After stent implantation, there were no relapse angina symptoms on drug treatment, and according to our examination guideline for patients with borderline stenoses, a treadmill test was performed. The test was positive; therefore, FFR assessment was recommended, with coronary multi-slice CT being performed. The following results were obtained: FFRct LAD – 0.57; FFRct LCX – 0.88. An invasive assessment of FFR was also performed as a reference standard and revealed: FFR LAD – 0.6; FFR LCX – 0.88, and simultaneously a LAD percutaneous coronary intervention (PCI) was performed. Three months later, the patient underwent a stress test, which revealed no evidence of induced ischemia.

CONCLUSIONS: Our method of noninvasive assessment of FFR has shown encouraging results, but we believe that larger-scale studies are needed to establish it as common clinical practice.

Keywords: Coronary Artery Disease, Fractional Flow Reserve, Myocardial, Models, Theoretical

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923