Evaluating intermediate coronary lesions in the cardiac catheterization laboratory

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Angiography struggles to differentiate between ischemia-causing and non-ischemia-causing intermediate coronary lesions.
• Accurate assessment of moderate coronary stenoses is crucial for guiding treatment decisions.

Purpose of the Study:

• To review invasive modalities for assessing the physiologic significance of intermediate coronary lesions.
• To compare the efficacy and limitations of Doppler wire-derived coronary flow reserve (CFR), pressure wire-derived fractional flow reserve (FFR), and intravascular ultrasound (IVUS).

Main Methods:

• Review of studies correlating CFR, FFR, and IVUS with noninvasive tests like nuclear perfusion imaging and stress echocardiography.
• Analysis of the limitations inherent in each invasive modality.

Main Results:

• Coronary flow reserve (CFR) is limited by heart rate and blood pressure variability, impacting reproducibility.
• Both CFR and fractional flow reserve (FFR) require maximal hyperemia, posing a practical challenge.
• Intravascular ultrasound (IVUS) provides only anatomical data, not functional significance.

Conclusions:

• Fractional flow reserve (FFR) emerges as the superior method for interrogating intermediate coronary lesions.
• FFR offers a more reliable assessment of lesion significance compared to CFR and IVUS.