FFRCT Findings Without Visible Stenosis: Interpretation and Clinical Significance

Understanding FFRCT Drops and Diffuse Disease Patterns

In arteries with diffuse atherosclerotic disease, coronary pressure noticeably declines along the length of the artery, unlike normal vessels where FFR remains 0.97 ± 0.02, according to the American Heart Association 1, 2
The European Society of Cardiology recommends that FFRCT values be interpreted with caution, as diffuse diameter changes along the vessel length increase resistance, causing progressive pressure loss that manifests as gradual FFRCT decline 1, 2
The American College of Cardiology suggests that gradually decreasing FFRCT values at the distal vessel without a proximal focal lesion is specifically recognized as a pattern of diffuse atherosclerosis, with a reported average FFR of 0.89 ± 0.08 in nonstenotic arteries from patients with atherosclerosis elsewhere 1, 2

The American Heart Association recommends that FFR should not be considered a marker for revascularization in patients with diffuse coronary atherosclerosis showing a graded, continuous pressure fall along the arterial length 7, 9
The European Society of Cardiology suggests that aggressive medical therapy is the primary treatment approach, including aspirin for antiplatelet effect, high-intensity statin therapy, and antianginal medications as needed for symptom control 5
The American College of Cardiology recommends considering invasive FFR measurement if revascularization is being contemplated, as FFRCT has known limitations and invasive FFR remains the gold standard for decision-making 4, 5, 6

Microvascular dysfunction can cause abnormal distal FFRCT with normal epicardial arteries, particularly in patients with hypertension and left ventricular hypertrophy, diabetes mellitus, or female sex, according to the European Heart Journal 3, 11
The European Society of Cardiology suggests measuring coronary flow reserve (CFR) and index of microvascular resistance (IMR) if invasive assessment is performed, as these provide complementary information about microvascular function 3