Implications of Low-Normal Ejection Fraction and Small Distal RCA
Your ejection fraction of 58% is within normal range and carries excellent prognosis, while the small distal right coronary artery with anomalous origin requires monitoring but does not independently predict adverse outcomes in the absence of ischemia or symptoms. 1, 2
Ejection Fraction Assessment
Your left ventricular ejection fraction of 58% falls within the normal range (≥50%) and represents preserved systolic function. 3
Key prognostic considerations:
In coronary artery disease patients undergoing PCI, mortality and major adverse cardiovascular events increase significantly only when ejection fraction falls below 55%. 2 Your EF of 58% places you above this threshold with favorable prognosis.
Rest left ventricular ejection fraction is one of the most important determinants of long-term prognosis in patients with chronic stable coronary artery disease, with mortality rates increasing progressively only as LVEF decreases below normal ranges. 1
Patients with LVEF ≥55% have substantially lower mortality risk compared to those below this threshold—your 58% EF confers protective benefit. 2
The gradient-response relationship shows that adverse outcomes concentrate in patients with reduced ejection fraction, particularly below 40%, where hospital survival drops to 63% and 3-year survival to 15%. 4 Your preserved EF avoids these risks entirely.
Right Coronary Artery Findings
The anatomical variant described—RCA origin 6mm above the right coronary cusp with initial acute angle—represents a congenital coronary anomaly that requires specific consideration. 1
Clinical significance:
The small caliber and poorly visualized distal RCA segment, in the context of left coronary dominance, indicates the RCA is non-dominant and supplies a smaller myocardial territory. 1 This anatomical pattern reduces the functional impact of any RCA abnormality.
The anomalous origin with acute angle takeoff can theoretically predispose to ischemia during increased myocardial demand, though your study shows no atherosclerotic plaque or hemodynamically significant stenosis in the proximal and mid segments. 1
In strictly normal coronary arteries, fractional flow reserve averages 0.97 ± 0.02, whereas in nonstenotic arteries in patients with atherosclerosis elsewhere, FFR averages 0.89 ± 0.08. 1 Your completely normal coronary arteries without any atherosclerotic plaque suggest optimal coronary physiology.
The absence of coronary calcium (score of zero) strongly indicates absence of significant atherosclerotic disease and excellent prognosis. 3
Cardiac Function and Stroke Volume
Your stroke volume of 90 mL is within normal range and, when indexed to body surface area, likely exceeds the 35 mL/m² threshold that defines normal flow states. 3
Functional implications:
Normal stroke volume with preserved ejection fraction indicates absence of the "paradoxical low-flow" state seen in some cardiac conditions, confirming normal ventricular-arterial coupling. 3
The combination of normal EF (58%), normal stroke volume (90 mL), and absence of left ventricular hypertrophy or dilation indicates optimal cardiac mechanics without afterload mismatch. 3
Risk Stratification and Prognosis
Your cardiac profile indicates low cardiovascular risk:
Zero coronary calcium score combined with no atherosclerotic plaque provides strong negative predictive value for future cardiac events. 5
Normal coronary anatomy in all three major epicardial vessels without stenosis eliminates obstructive coronary disease as a concern. 1
Preserved ejection fraction above 55% confers substantially lower risk of major adverse cardiovascular events compared to reduced EF states. 2
The presence of mitral annular calcifications noted in your study represents age-related degenerative changes but does not independently predict adverse outcomes in the absence of valvular dysfunction. 1
Clinical Management Implications
No intervention is indicated based on these findings. 1
The anomalous RCA origin with acute angle requires documentation but does not mandate intervention in the absence of ischemia, symptoms, or hemodynamic significance. 1
Continue standard cardiovascular risk factor modification including management of any hypertension, hyperlipidemia, or diabetes. 6
Routine surveillance imaging is not indicated for asymptomatic patients with normal coronary arteries and preserved ventricular function. 1 Repeat testing should be symptom-driven rather than time-based.
If exertional symptoms develop, stress testing with perfusion imaging would be appropriate to assess for exercise-induced ischemia related to the RCA anomaly. 1
Important Caveats
The small distal RCA visualization may represent either true anatomical hypoplasia in the setting of left dominance or technical limitations of CT angiography in visualizing small distal vessels. 1 This distinction has minimal clinical relevance given your left-dominant circulation where the circumflex supplies the posterior descending artery territory.
The acute angle takeoff of the RCA warrants awareness during any future invasive procedures, as catheter engagement may be technically challenging and require specific catheter selection. 1
Your normal ejection fraction and absence of coronary disease place you in a distinctly different risk category than patients with heart failure with preserved ejection fraction (HFpEF) and coronary disease, who face substantially higher morbidity. 7, 6