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.

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.