A patient with near 90% LAD disease who had a significant TMT/EST positivity with no clinical angina was subjected to FFR by a scientific cardiac physician. Since FFR was recorded as .9 , he was adviced against a stent and sent home with drugs.
Now , in the physiological assessment of a coronary lesion , which one you are going to trust , TMT positivity or FFR ?
FFR measures trans-lesional pressure drop by creating a artificial exercise physiology in a particular coronary bed by injecting just one of coronary vasodilators namely Adenosine. FFR assessment can never be considered truely physiological .There has been huge discrepancy in the amount , rate and route of administration and the hyperemic response to Adenosine.
Final message
In a single vessel disease population , if TMT is positive the lesion is to be taken as significant, irrespective of FFR.(Provided Anemia and other systemic factors are excluded )
*Read this and get ready to get confused further , single vessel disease with TMT positivity doesn’t mean medical management is never an option .OMT ,(optimal medical therapy ) even though a battered concept is not yet dead for SVD !
Dr.S.Venkatesan MD 