A 55-year-old woman complained of unusual chest pain that began one month
ago. She had no history of myocardial infarction or cardiovascular disease,
but had recently been diagnosed with Type 2 diabetes, hypertension and
hyperlipidaemia. She had a long history of smoking although had recently
given up. She had a sedentary lifestyle and did very little exercise.
An exercise stress test revealed no significant ECG abnormality and did not
cause her any chest pain. However, she subsequently underwent a high
definition low dose coronary CT scan which showed that she had calcified
coronary arteries with a possibly significant lesion in the proximal Left Anterior
Descending coronary artery (LAD).
Her cardiologist decided to perform a non-invasive HeartFlow FFRct® Analysis,
which showed a functionally significant stenosis with a computed FFRct®
value of 0.66. The finding of an ischaemia-producing lesion in the LAD was
subsequently confirmed at the time of invasive coronary angiography, with
direct measurement of Fractional Flow Reserve (FFR) using a pressure wire.
The measured FFR was 0.67, which closely matched the computed value from
the HeartFlow study.
With a clear diagnosis of ischaemia, the patient was treated at the same
procedure with a coronary stent, which relieved her unusual chest pain
symptoms. One year later, she had not experienced any further chest pains,
felt completely well and was actively engaged in a structured exercise
programme and walking on a daily basis.
Coronary artery disease and diagnosis
Coronary artery disease is the leading cause of death in the UK, affecting more
than one in seven men and nearly one in ten women.
Despite the widespread
use of non-invasive cardiac diagnostic testing, functionally significant coronary
disease is often missed while, at the same time, many patients with positive
stress tests have no significant disease.
In a study of almost 400,000 patients with suspected coronary artery disease
who underwent Invasive Coronary Angiography (ICA), 84% had prior non-
invasive tests, but more than 60% had no evidence of obstructive coronary
disease on angiography.
A recent multicentre trial showed that using
HeartFlow FFRct® Analysis improved the selection of patients for coronary
angiography with more than 80% reduction in the number of angiograms
showing no obstructive disease, and a significant reduction in healthcare cost.
Coronary Heart Disease
(CHD) Statistics for the UK
CHD is responsible for nearly
70,000 deaths in the UK each
year, an average of 190 people
each day, or one death around
every eight minutes. Most deaths
from coronary heart disease are
caused by a heart attack.
More than 22,000 people under
the age of 75 in the UK die from
CHD each year.
CHD death rates are highest
in Scotland and the north of
England and lowest in the
south of England.
CHD kills more than twice as
many women as breast cancer.
2.3 million people are living
with CHD in the UK – over 60%
British Heart Foundation
Cardiovascular Statistics UK
2. Patel et al,
predictors of non-obstructive
coronary artery disease identified
with coronary angiography in
contemporary clinical practice.
American Heart Journal 2014;
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MORE THAN 22,000
PEOPLE UNDER THE
AGE OF 75 IN THE UK DIE
FROM CHD EACH YEAR