Physiologic Assessment of Coronary Artery Disease: Focus on Fractional Flow Reserve

Area of Science:

• Cardiology
• Medical Imaging
• Physiology

Background:

• Myocardial ischemia is a key prognostic factor in ischemic heart disease.
• Fractional flow reserve (FFR) is the gold standard for detecting stenosis-specific ischemia.
• FFR-guided revascularization improves patient outcomes over angiography-guided strategies.

Purpose of the Study:

• To provide a comprehensive understanding of physiologic assessment in ischemic heart disease.
• To review the basic and clinical aspects of invasive and non-invasive modalities.
• To highlight the roles and potential pitfalls of current assessment techniques.

Main Methods:

• Review of current literature on invasive and non-invasive physiologic assessment.
• Discussion of Fractional Flow Reserve (FFR) and its applications.
• Exploration of the instantaneous wave-free ratio (iFR) and non-invasive FFR from coronary CT angiography.

Main Results:

• FFR-guided revascularization is superior to angiography-guided strategies.
• Non-invasive FFR derived from coronary CT angiography is clinically applicable.
• The instantaneous wave-free ratio is under active investigation as a hyperemia-free index.

Conclusions:

• A thorough understanding of both invasive and non-invasive physiologic assessment is crucial for effective clinical application.
• Continued research into hyperemia-free indices and non-invasive methods is warranted.
• Accurate assessment of myocardial ischemia is vital for optimizing patient prognosis in ischemic heart disease.