Invasive FFR and Noninvasive CFR in the Evaluation of Ischemia: What Is the Future?

Area of Science:

• Cardiology
• Physiology
• Medical Diagnostics

Background:

• Atherosclerosis diagnosis and management rely on clinical events as the gold standard.
• Coronary physiology plays a crucial role in assessing coronary artery disease.
• Current diagnostic tests, including invasive fractional flow reserve and noninvasive coronary flow reserve, are evaluated for their impact on patient outcomes.

Purpose of the Study:

• To provide an integrative and forward-looking perspective on coronary physiology.
• To examine the role of coronary physiology in the diagnosis and management of atherosclerosis.
• To identify underexplored areas in coronary physiology for future research and treatment testing.

Main Methods:

• Review of existing literature on coronary physiology.
• Categorization of patients into acute and stable coronary disease groups.
• Analysis of the potential of coronary physiology to refine treatment strategies.

Main Results:

• Coronary physiology can potentially refine treatment for culprit lesions in acute coronary disease.
• Reducing hard endpoints with revascularization in stable and nonculprit disease may occur at the severe end of the physiological spectrum.
• Nonepicardial disease and diffuse atherosclerosis represent underexplored areas for coronary physiology testing.

Conclusions:

• The future utility of coronary physiology diagnostics hinges on their ability to improve patient outcomes.
• Further research into nonepicardial and diffuse atherosclerosis is needed.
• Coronary physiology offers potential for optimizing treatment in various coronary disease scenarios.