Figure 6.

Case example comparing coronary CTA, FFR-CT, and invasive angiography results. A 71-year-old male presented with exertional chest pain. He exercised for 10 min on a Bruce protocol, experienced reproducible chest pain but had no significant ECG changes. He underwent coronary CTA, which showed a 70–95% ostial left anterior descending (LAD) coronary artery narrowing (A). Invasive angiography confirmed the 70–95% ostial LAD narrowing (B) and the artery was stented (C). The coronary CTA also showed a 25–49% mid right coronary artery (RCA) narrowing followed by a 70–95% distal narrowing (D). The mid RCA narrowing was judged minimal on invasive angiography and the distal RCA a 50% narrowing that did not undergo stenting (E). FFR-CT was 0.76 in the LAD that underwent stenting and 0.82 in the RCA that did not undergo stenting (F), predicting decision-making in the cardiac catheterization laboratory. The patient was asymptomatic at 2-year follow-up. The solid white arrows represent the stenotic segments identified on coronary CTA (A and D) or invasive angiography (B and E). The dashed white arrow represents the revascularized LAD stenotic segment (C). The FFR-CT values in each coronary territory are depicted in colour scale, and the numerical values of the worst FFR-CT determined in distal segments provided (F). A colour-scale graph of FFR-CT values is also presented (F). LCX, left circumflex coronary artery.