• The occult hemodynamically significant left main stenosis in the asymptomatic patient: Reconciling the visual-functional mismatch – A case report and review of screening appropriateness and assessment

    Abstract

    We present a 40 year old asymptomatic man with mild left main artery narrowing who demonstrated extreme discordance between symptom presentation and ischemic burden i.e. visual (angiographic) and ischemic (functional) mismatch. The use of an appropriately selected screening stress test can lead to an appropriate decision for revascularization, supported by landmark risk assessment documents and revascularization trials.

    Highlights

     

    • Conflicting guidelines, scientific statements, and opinions underscore the management challenge for the clinician when deciding on a screening stress test for an asymptomatic patient without previously known coronary artery disease and good functional status.
    • The symptom and ischemic burden mismatch can be severe in an asymptomatic patient.
    • The functional and visual mismatch is another challenge in fully evaluating the ischemic burden. And Fractional Flow Reserve, FFR, is crucial in fully elucidating the ischemic burden.

    Source:

    Cardiovascular Revascularization Medicine, 2018-10-01, Volume 19, Issue 7, Pages 805-809, Copyright © 2018

     

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