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Wolff-Parkinson-White Syndrome — EECC MCQ

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HardArrhythmia & ElectrophysiologyWolff-Parkinson-White SyndromeEECC

A patient with angina and unobstructed coronary arteries undergoes pressure-temperature wire testing. FFR is 0.93, coronary flow reserve is 1.5 and index of microvascular resistance is 13. Resting mean transit time is unusually short and hyperaemic transit time is normal. Which physiological interpretation is best?

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Reveal the answer and explanation

Correct answer: E — High resting flow causing low CFR despite normal minimal resistance

The best answer is “High resting flow causing low CFR despite normal minimal resistance”. Coronary flow reserve is a ratio of hyperaemic to resting flow; it can be reduced by excessive resting flow even when hyperaemic resistance is normal, so CFR and IMR must be interpreted together. “Fixed epicardial disease despite a normal fractional flow reserve” is less appropriate because the normal FFR argues against a flow-limiting epicardial stenosis “Structural microvascular disease with abnormally elevated minimal resistance” is less appropriate because a normal IMR does not support elevated minimal microvascular resistance “Entirely normal coronary physiology despite reduced coronary flow reserve” is less appropriate because FFR assesses epicardial pressure loss and cannot by itself declare the microcirculation normal “Acetylcholine-provoked epicardial vasospasm without provocation testing” is less appropriate because no acetylcholine provocation or severe epicardial constriction is described

Reference: 2024 ESC Guidelines for chronic coronary syndromes. https://academic.oup.com/eurheartj/article/45/36/3415/7743115