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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Ischemia-based Coronary Revascularization: Beyond Anatomy and Fractional Flow Reserve
Hong Seok Lim1, Kyoung Woo Seo1, Myeong Ho Yoon1
1Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
Insights
Fractional flow reserve (FFR) guides treatment for coronary artery disease (CAD) by assessing myocardial ischemia. Integrating FFR with anatomical data improves clinical outcomes, despite current underutilization in practice.
Area of Science:
- Cardiology
- Interventional Cardiology
- Physiology
Background:
- Coronary artery disease (CAD) treatment requires objective evidence of inducible ischemia for optimal outcomes.
- Fractional flow reserve (FFR) is the gold standard for invasively assessing lesion-specific myocardial ischemia.
- Current guidelines emphasize ischemia-based revascularization, yet visual assessment often prevails in clinical practice.
Purpose of the Study:
- To review limitations of anatomy-based stenosis evaluation.
- To detail clinical utility considerations for FFR.
- To discuss the importance of an integrated physiologic approach in CAD management.
Main Methods:
- Review of current literature on FFR and anatomical assessment in CAD.
- Analysis of discordance between functional and anatomical evaluations.
- Discussion of factors influencing FFR interpretation.
Main Results:
- Anatomical assessment alone has limitations in determining functional significance of coronary stenosis.
- Significant discordance exists between anatomical and functional assessments.
- Evidence supporting anatomy-guided percutaneous coronary intervention (PCI) is limited compared to FFR-guided PCI.
Conclusions:
- An integrated physiologic approach is crucial for accurate CAD treatment strategies.
- FFR-guided PCI is recommended, but accurate interpretation requires awareness of influencing factors.
- Improving the clinical application of FFR is essential for evidence-based CAD management.
Abstract:
Treatment strategies for patients with coronary artery disease (CAD) should be based on objective evidence of inducible ischemia in the subtended myocardium to improve clinical outcomes, symptoms, and cost-effectiveness. Fractional flow reserve (FFR) is the most verified index to-date for invasively evaluating lesion-specific myocardial ischemia. Favorable results from large clinical trials that applied FFR-guided percutaneous coronary intervention (PCI) prompted changes in coronary revascularization guidelines to emphasize the importance of this ischemia-based strategy using invasive coronary physiology. However, the frequency of functional evaluations is lacking in daily practice, and visual assessment still dominates treatment decisions in CAD patients. Despite recent efforts to integrate functional and anatomical assessments for coronary stenosis, there is considerable discordance between the 2 modalities, and the diagnostic accuracy of simple parameters obtained from current imaging tools is not satisfactory to determine functional significance. Although evidence that supports or justifies anatomy-guided PCI is more limited, and FFR-guided PCI is currently recommended, it is important to be aware of conditions and factors that influence FFR for accurate interpretation and application. In this article, we review the limitations of the current anatomy-derived evaluation of the functional significance of coronary stenosis, detail considerations for the clinical utility of FFR, and discuss the importance of an integrated physiologic approach to determine treatment strategies for CAD patients.
