Related Experiment Video
Updated: Aug 12, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Adequate patient selection for coronary revascularization: an overview of current methods used in daily clinical
Steven A J Chamuleau1, Berthe L F van Eck-Smit, Martijn Meuwissen
1Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands. s.a.chamuleau@amc.uva.nl
Insights
Non-invasive stress tests effectively identify coronary artery disease (CAD) and guide risk stratification. Invasive hemodynamic parameters like fractional flow reserve (FFR) accurately assess lesion severity, preventing unnecessary interventions.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Interventional Cardiology
Background:
- Non-invasive stress modalities (exercise ECG, MPS, stress echocardiography) are primary tools for diagnosing Coronary Artery Disease (CAD).
- Non-invasive assessment of perfusion abnormalities aids in risk stratification for CAD patients.
- Stress testing is crucial before cardiac catheterization to confirm myocardial ischemia, a prerequisite for coronary revascularization.
Purpose of the Study:
- To evaluate the role of invasive hemodynamic parameters (Coronary Flow Velocity Reserve - CFVR, Fractional Flow Reserve - FFR) in assessing functional severity of coronary narrowings.
- To compare the accuracy of invasive hemodynamic parameters with non-invasive stress tests in CAD assessment.
- To determine the safety and clinical utility of deferring Percutaneous Transluminal Coronary Angioplasty (PTCA) based on normal CFVR and FFR values.
Main Methods:
- Utilized invasive hemodynamic parameters, specifically CFVR and FFR, during cardiac catheterization.
- Compared CFVR and FFR results with established non-invasive stress testing outcomes.
- Analyzed the application of these indices in 'ad hoc' PTCA settings and for patients with multivessel CAD.
Main Results:
- FFR and CFVR effectively identify the functional severity of specific coronary lesions, showing good agreement with non-invasive stress test results.
- Normal FFR and CFVR values support the safety of deferring PTCA procedures.
- These indices facilitate selective evaluation of coronary narrowings in multivessel CAD, aiding clinical decision-making.
Conclusions:
- Invasive hemodynamic parameters (FFR, CFVR) provide crucial functional information on coronary stenoses, complementing anatomical data from coronary angiography.
- Utilizing FFR and CFVR can help avoid unnecessary revascularization procedures, which are costly and carry potential risks.
- These parameters are valuable tools for guiding therapeutic decisions in CAD management, particularly in 'ad hoc' PTCA and multivessel disease scenarios.
Abstract:
Widely used non-invasive stress modalities, like exercise ECG, MPS and stress-echocardiography, are the tests of first choice for the diagnosis of CAD. It has been shown in numerous studies that non-invasive assessment of perfusion abnormalities is an adequate strategy for risk stratification. Moreover, non-invasive stress testing should be performed before a diagnostic cardiac catheterization to document the presence of myocardial ischemia, as a prerequisite for coronary revascularization. Coronary angiography is the gold standard for identifying CAD; however this technique is limited in assessing functional severity of coronary narrowings ('illusion of luminology'; see also Figure 5). The recently introduced i.c. hemodynamic parameters (CFVR and FFR) can identify functional severity of specific lesions and have shown a good agreement with the results of non-invasive stress test in validation studies. Furthermore, there is accumulating evidence that it is safe to defer a PTCA procedure, based on normal FFR and CFVR values. As these indices are derived during an invasive cardiac catheterization procedure, its use is recommended during a so called 'ad hoc' PTCA setting. Furthermore, they are particularly useful for clinical decision making in patients with documented multivessel CAD, as both indices allow selective evaluation of coronary narrowings in different arteries. Revascularization procedures are costly and always have a potential risk. It is important to be aware that, using above mentioned methods, unnecessary interventions (lacking potential benefit) may be avoided.
More Related Videos
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Angina IV: Management