case_images: PMC4322374_01
case_images: 52-year-old male with atypical chest pain. Coronary computed tomography angiography curved planar reformation image of the mid left anterior descending coronary artery. The white arrow marks an area suspicious for significant stenosis (>70%).
case_images: JCIS-5-3-g002.jpg
case_images: PMC4322374_01_JCIS-5-3-g002.jpg
case_images: F1
case_images: The calcium score was 140 and CCTA revealed calcified and noncalcified coronary atherosclerosis with a mixed, stenotic plaque in the mid left anterior descending coronary artery (LAD) [Figure 1].
case_images: 52-year-old male with atypical chest pain. Static rubidium-82 perfusion images (17 segment polar maps) demonstrates no difference between stress (top) and rest perfusion (bottom). Images were acquired 150 s after injection of 1110 MBq Rb82. Total acquisition time was 270 s.
case_images: JCIS-5-3-g003.jpg
case_images: PMC4322374_01_JCIS-5-3-g003.jpg
case_images: F2
case_images: Myocardial perfusion and coronary flow reserve were normal during adequate stress response to adenosine (140 mug/kg/min) [Figure 2].
case_images: 53-year-old male presenting with severe chest pain and cardiac arrest, which was successfully treated with resuscitation and cardioversion. 12-lead electrocardiogram shows massive ST-elevation consistent with anterior ST-elevation myocardial infarction.
case_images: JCIS-5-3-g004.jpg
case_images: PMC4322374_01_JCIS-5-3-g004.jpg
case_images: F3
case_images: The electrocardiogram showed ST-elevation [Figure 3].
case_images: 53-year-old male presenting with severe chest pain and cardiac arrest, which was successfully treated with resuscitation and cardioversion. Invasive angiography shows prestent image of left anterior descending coronary artery occlusion marked by the white arrow (left side, angiography projection: 4  right anterior oblique and 24  cranial) and poststent image of re-perfused left anterior descending coronary artery with the white arrow marking the point of previous occlusion (right side, angiography projection: 6  right anterior oblique and 30  cranial).
case_images: JCIS-5-3-g005.jpg
case_images: PMC4322374_01_JCIS-5-3-g005.jpg
case_images: F4
case_images: Normal coronary flow was restored after recanalization and stenting [Figure 4].
case_images: 52-year-old male with atypical chest pain. Fractional flow reserve (FFRCT = 0.52) derived from coronary computed tomography images and based on a physiologic model of coronary blood flow using three principles: (1) The total resting coronary blood flow can be quantified relative to the myocardial mass, (2) The microcirculatory vascular resistance at rest is inversely proportional to the size of the supplying coronary arteries, and (3) The vasodilatory response of the coronary microcirculation to adenosine can be predicted, allowing computational modeling of maximal hyperemia. The integration of the physiological model into 3-dimensional computational models allows computation of coronary flow and pressure under hyperemic conditions.
case_images: JCIS-5-3-g006.jpg
case_images: PMC4322374_01_JCIS-5-3-g006.jpg
case_images: F5
case_images: FFRCT analysis [Figure 5]. FFRCT analysis was performed at HeartFlow (Redwood