Case 3:

A Patient with Complex Bifurcation Disease,

Simplified by Physiology

Jennifer A Tremmel, MD, MS

Stanford University Medical Center
 Disclosure Statement of Financial Interest

Within the past 12 months, I or my spouse/partner have had a

financial interest/arrangement or affiliation with the
organization(s) listed below.

Affiliation/Financial Relationship Company

Consulting Fees/Honoraria Boston Scientific, Philips, Terumo
Major Stock Shareholder/Equity Recor
 Case
• 55 yo man with hyperlipidemia, a remote 10-15 pack yr history of
tobacco use, morbid obesity (BMI 48), and a family h/o CAD
(father died from MI at age 53)

• Presents with progressive exertional shortness of breath and

fatigue over the past few months to the point that he now gets
his symptoms after getting in his car; symptoms resolve within 1
minute of rest

• Stress test with a mostly reversible perfusion defect in the

inferior wall involving 15-20% of the LV, along with mild transient
ischemic dilation (EF 40%)
• What next?
• FFR LCx = 0.64
• FFR LAD = 0.64