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Updated: Apr 16, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Invasive measures of myocardial perfusion and ischemia
Julien Adjedj1, Gabor G Toth2, Bernard De Bruyne1
1Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
Insights
Coronary artery disease (CAD) assessment is shifting from subjective angiograms to objective functional measurements. Invasive methods now quantify coronary pressure and flow, improving diagnosis and management.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Coronary artery disease (CAD) diagnosis traditionally relied on subjective interpretation of invasive angiograms, focusing on anatomical stenosis.
- This anatomical approach showed poor correlation with actual functional impact on the heart.
Purpose of the Study:
- To review the characteristics of invasive functional indices used to assess ischemia and perfusion in CAD.
- To highlight the shift towards integrating functional data with anatomical information for better CAD management.
Main Methods:
- Review of invasive, wire-based techniques for quantifying coronary pressure and flow with high spatial resolution.
- Discussion of functional indices derived from these measurements.
Main Results:
- Purely angiographic metrics correlate poorly with functional data.
- Invasive functional indices provide crucial information for accurate CAD assessment.
Conclusions:
- Both anatomical and functional information are essential for defining CAD and optimizing patient management.
- Invasive functional assessment represents a significant advancement in understanding and treating CAD.
Abstract:
Until recently, our understanding of coronary artery disease (CAD) has been largely based on a purely anatomical approach as derived from the invasive angiogram. The confirmation of the diagnosis of "significant" CAD, the assessment of its extent, the risk stratification of patients, the therapeutic decisions, the definition of study end-points, and the validation of non-invasive testing, all mainly relied on "eyeballing" the angiogram, i.e. a subjective evaluation of the presence of at least 50% (or 70%) diameter stenosis.With the development of invasive, wire-based, means to quantify coronary pressure and flow with high spatial resolution, one realized that purely angiographic metrics correlated poorly with functional information. Currently, it is admitted that both anatomical and functional information are needed to define CAD and to optimize its management. In the present review, we summarize the main characteristics of invasive functional indices of ischemia and perfusion.
