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. 2021 Dec;31(12):8975-8982.
doi: 10.1007/s00330-021-08027-0. Epub 2021 May 26.

Prevalence of pathological FFRCT values without coronary artery stenosis in an asymptomatic marathon runner cohort

Sebastian Gassenmaier  1 , Ilias Tsiflikas  1 , Simon Greulich  2 , Jens Kuebler  1 , Florian Hagen  1 , Konstantin Nikolaou  1 , Andreas M Niess  3 , Christof Burgstahler  4 , Patrick Krumm  1
Affiliations

Prevalence of pathological FFRCT values without coronary artery stenosis in an asymptomatic marathon runner cohort

Sebastian Gassenmaier et al. Eur Radiol. 2021 Dec.

Abstract

Objectives: To evaluate computed tomography fractional flow reserve (FFRCT) values in distal parts of the coronaries in an asymptomatic cohort of marathon runners without any coronary stenosis for potentially false-positive values.

Methods: Ninety-eight asymptomatic male marathon runners (age 53 ± 7 years) were enrolled in a prospective monocentric study and underwent coronary computed tomography angiography (CCTA). CCTA data were analyzed for visual coronary artery stenosis. FFRCT was evaluated in 59 participants without coronary artery stenosis in proximal, mid, and distal coronary sections using an on-site software prototype.

Results: In participants without coronary artery stenosis, abnormal FFRCT values ≤ 0.8 in distal segments were found in 22 participants (37%); in 19 participants in the LAD; in 5 participants in the LCX; and in 4 participants in the RCA. Vessel diameters in participants with FFRCT values > 0.80 compared to ≤ 0.80 were 1.6 ± 0.3 mm versus 1.5 ± 0.3 mm for distal LAD (p = 0.025), 1.8 ± 0.3 mm versus 1.6 ± 0.5 mm for distal LCX (p = 0.183), and 2.0 ± 0.4 mm versus 1.5 ± 0.2 mm for distal RCA (p < 0.001).

Conclusions: Abnormal FFRCT values of ≤ 0.8 frequently occurred in distal coronary segments in subjects without any anatomical coronary artery stenosis. This effect is only to some degree explainable by small distal vessel diameters. Therefore, the validity of hemodynamic relevance evaluation using FFRCT in distal coronary artery segment stenosis is reduced.

Key points: • Abnormal FFRCT values (≤ 0.8) occurred in over a third of the subjects in the distal LAD despite the absence of coronary artery stenosis.. • Therefore, the validity of hemodynamic relevance evaluation in distal coronary artery segment stenosis is reduced. • Decision-making based on abnormal FFRCT values in distal vessel sections should be performed with caution and only in combination with visual assessment of the grade of stenosis..

Keywords: Computed tomography angiography; Coronary artery disease; Fractional flow reserve; Myocardial; Running.

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Conflict of interest statement

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
The flowchart of this study
Fig. 2
Fig. 2
Example of FFRCT evaluation without coronary stenosis. Despite the absence of coronary stenosis, the FFRCT evaluation resulted in values of ≤ 0.8 in the distal section. The location of FFRCT measurement is marked by an arrow. Abbreviations: FFRCT, CT fractional flow reserve
See this image and copyright information in PMC

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