Georges A. Saade, MD, FESC, FACC, a senior consultant cardiologist, presents a research case study on the use of CT Fractional Flow Reserve (CT-FFR) with DeepVessel FFR in diagnosing cardiovascular disease. The CT-FFR was performed at the Doctors Center Radiology and Laboratory, Beirut. The case highlights key diagnostic steps, ultimately validated by coronary angiography, which confirmed the accuracy of the CT-FFR findings. The approach enhances diagnostic accuracy and treatment outcomes for patients with CAD, optimizing resource utilization and minimizing unnecessary invasive procedures.
Georges A. Saade, MD, FESC, FACC
Senior Consultant Cardiologist, Clinical Associate Professor of Cardiology, University of Balamand, Elected President of Lebanese Society of Cardiologist, Bellevue Medical Center, Lebanon
Case Study
A 69-year-old male with a medical history of type 2 diabetes since 1995, currently well-controlled on oral medications, and hypertension since 2010, also well-controlled, presented with atypical chest pain. His history includes a laminectomy in 2004 and a laser prostatectomy for benign prostatic hyperplasia.
An echocardiogram showed left ventricular diastolic dysfunction, with no regional wall motion abnormalities and an ejection fraction of 59%. A stress echocardiogram was performed but was inconclusive due to limited exercise tolerance. CT angiography revealed an elevated calcium score of 670, a significant calcified lesions in the LAD, circumflex, and RCA.
A CT-derived fractional flow reserve (CT-FFR) was ordered to further assess functional and anatomical coronary stenosis, confirming a functional lesion in the distal LAD, Cx, and distal RCA. Given the patient’s long history of diabetes and multi-vessel coronary disease, the heart team recommended coronary artery bypass graft surgery.
A planned coronary angiography confirmed the CT-FFR findings of severe triple vessel CAD, concluding:
- 50% proximal LAD stenosis. 70% calcified stenosis of the mid LAD. Severely diseased distal LAD over a long segment (~40-50 mm) with 99% stenosis. 70-80% stenosis of the apical LAD. 95% stenoses of the 1st and 3rd diagonals.
- 90% proximal LCX stenosis. 95% stenosis of the middle LCX. 70-80% stenoses of the OM1. 80% ostial stenoses of the OM2 and OM3.
- 50% and 70% stenoses of the mid RCA. 70% stenosis of the distal RCA.
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