FFR in angina
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The document outlines the approach to diagnosing and treating a patient with angina, focusing on the use of Fractional Flow Reserve (FFR) and myocardial perfusion imaging. It presents a case study of a 35-year-old male with multiple health issues who presented with typical angina, detailing his clinical parameters and diagnostic tests. The document emphasizes the importance of FFR in assessing ischemia and guiding treatment decisions in patients with stable and unstable angina.
FFR in angina
- 1. How I approach the patient with angina Dr. S K Agarwal MD, DM, FACC, CBCCT Consultant Interventional Cardiologist Rashid Hospital Dubai
- 2. FFR and MVD Detection vs. Localization of ischemia Test Spatial resolution Exercise ECG Patient level Stress Echo Myocardial territory Stress MRI Myocardial territory Myocardial perfusion imaging Myocardial territory FFR Cm (mm)
- 3. FFR and MVD Detection and Localization of ischemia Vessel related ischemia FFR: “Myocardial Perfusion Imaging available at tip of wire”
- 4. Clinical data • 35 yrs. male , DM 3yrs , Dyslipidemic , IHD ( AWMI in 2015, rescue PCI with 1 DES in LAD ), smoker and occasionally alcoholic , on regular medication • presented to ER with typical angina. • BP: 140/89, PR: 86, wt. 56kg • ECG: No dynamic ECG changes • Echo: Moderately impaired LV systolic Fx. EF 40 % • Normal Cr, electrolytes, negative Trop T, A1c 6.8 28/7/2017 7/12/2016 22/10/2015 Chol 134 122 323 HDL 32 34 37 LDL 79 72 250 Trig 232 131 370
- 7. CAG Where is the significant lesion?
- 8. CAG Where is the significant lesion? 1) LAD 2) OM 3) Both or none
- 10. FFR of OM
- 11. PCI to OM
- 12. Post PCI FFR
- 13. FFR of LAD
- 14. Post PCI to LAD
- 15. Post PCI FFR Cause of +ve FFR post PCI Diffuse distal disease
- 16. Appropriateness criteria of doing PCI in DVD
- 17. FFR in UA & N STEMI Experience from FAME J Am Coll Cardiol Intv 2011;4: 1183 Stable vs. unstable Same benefit in patients of stable / unstable angina
- 19. FFR is the new lens for occulo-stenotic reflex
- 20. Look beyond angiographic anatomy • Thank you
Editor's Notes
- #18: The use of FFR to guide PCI has been well established for patients with SA. Of 1,005 patients, 328 had UA or NSTEMI. Using FFR to guide PCI resulted in similar risk reductions of MACE and its components in patients with UA or NSTEMI, compared with patients with SA (absolute risk reduction of 5.1% vs. 3.7%, respectively, p =0.92).