{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:52:43Z","timestamp":1792803163087,"version":"4.5.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec id=\"ab-hbr250012-4\"><jats:title>Importance<\/jats:title><jats:p>Right anomalous aortic origin of a coronary artery (R-AAOCA) is a rare congenital condition increasingly diagnosed with the growing use of cardiac imaging. Due to dynamic compression of the anomalous vessel, invasive fractional flow reserve (FFR) during a dobutamine-atropine volume challenge (FFR-dobutamine) is considered the reference standard. A reliable alternative method is needed to reduce extensive invasive testing, but it remains uncertain whether noninvasive imaging can accurately assess the hemodynamic relevance of R-AAOCA.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr250012-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the diagnostic performance of noninvasive anatomical and functional cardiac imaging to determine the hemodynamic relevance of R-AAOCA compared with the FFR-dobutamine reference standard.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr250012-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was a prospective, single-center cohort study performed between June 2020 and January 2025. The study was conducted at a specialized coronary artery anomaly clinic in Bern, Switzerland. Consecutive adult patients with R-AAOCA with an interarterial\/intramural course and a right coronary dominance were included in the study.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr250012-7\"><jats:title>Interventions<\/jats:title><jats:p>All patients underwent coronary computed tomography angiography (CCTA), nuclear cardiac imaging, and invasive FFR-dobutamine testing.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr250012-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Hemodynamic relevance of the anomalous vessel was defined as an FFR-dobutamine value less than or equal to 0.8. Patients with stenotic atherosclerotic plaques in the anomalous vessel at the time of functional testing were excluded.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr250012-9\"><jats:title>Results<\/jats:title><jats:p>A total of 55 patients (mean [SD] age, 51\u2009[12] years; 37 male [67%]) with newly detected R-AAOCA and combined interarterial\/intramural course were included in the analysis. Median FFR-dobutamine was 0.87 (IQR, 0.80-0.91), and 15 cases (27%) were hemodynamically relevant (ie, FFR-dobutamine \u22640.8). Anatomical CCTA (ie, CCTA\u2013ostial minor axis) assessment demonstrated both a 100% sensitivity and negative predictive value with a receiver operating characteristic curve of 0.82, as well as a specificity of 57%, leading to rule out 23 cases (42%; ie, 58% of the hemodynamic nonrelevant cases). Functional nuclear imaging detected ischemia in 4 patients (7%; ie, 27% of hemodynamically relevant cases, all true positive, none false positive), resulting in a sensitivity of 27%, both specificity and positive predictive value of 100%, and an accuracy of 80% in predicting FFR-dobutamine less than or equal to 0.8.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr250012-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Results of this cohort study suggest that in adults with R-AAOCA, a multimodality diagnostic imaging approach applicable in a stepwise manner, starting with CCTA, which offers high diagnostic performance to exclude hemodynamic relevance\u2014and optionally complemented by functional imaging with modest diagnostic performance to rule in hemodynamic relevance\u2014may help to reduce the need for invasive testing to a subset of patients.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2025.2993","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T15:00:32Z","timestamp":1757516432000},"page":"1055","source":"Crossref","is-referenced-by-count":14,"title":["Noninvasive Anatomical and Functional Imaging for Hemodynamic Relevance in Right Coronary Artery Anomalies"],"prefix":"10.1001","volume":"10","author":[{"given":"Marius R.","family":"Bigler","sequence":"first","affiliation":[{"name":"Department of Cardiology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anselm W.","family":"Stark","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Caobelli","sequence":"additional","affiliation":[{"name":"University Clinic of Nuclear Medicine, Inselspital University Hospital of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Rominger","sequence":"additional","affiliation":[{"name":"University Clinic of Nuclear Medicine, Inselspital University Hospital of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Kakizaki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio G.","family":"Biccir\u00e8","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saddam M. A.","family":"Al-Sabri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Shiri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Siepe","sequence":"additional","affiliation":[{"name":"Centre for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital University Hospital of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Windecker","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland"},{"name":"Associate Editor, JAMA 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