Coronary pathophysiology in the cardiac catheterization laboratory

Area of Science:

• Cardiology
• Interventional Cardiology
• Physiology

Background:

• Coronary angiography is the standard for diagnosing and treating coronary artery disease (CAD).
• Some coronary artery lesions require further assessment to determine their symptomatic significance.
• Physiologic measures provide objective data to guide treatment decisions.

Purpose of the Study:

• To evaluate the role of direct coronary flow and pressure measurements in assessing coronary artery lesion significance.
• To review the validation of coronary flow reserve (CFR) and fractional flow reserve (FFR) against non-invasive ischemia tests.
• To explore the application of FFR in guiding percutaneous coronary interventions (PCI) across various lesion types.

Main Methods:

• Direct measurement of coronary flow during maximal hyperemia.
• Measurement of coronary pressure changes at maximal hyperemia.
• Validation of CFR and FFR against non-invasive myocardial ischemia assessments.

Main Results:

• CFR and FFR provide physiologic data to assess lesion significance in the cardiac catheterization lab.
• FFR has been validated against non-invasive tests for myocardial ischemia.
• FFR has demonstrated utility in guiding PCI for diverse coronary lesion subsets.

Conclusions:

• Physiologic assessment using CFR and FFR enhances the diagnostic and therapeutic capabilities beyond standard coronary angiography.
• FFR is a valuable tool for guiding PCI decisions in complex coronary artery disease scenarios.
• These physiologic measures are essential for optimizing patient management in interventional cardiology.