[Invasive physiological evaluation of coronary artery disease]

Area of Science:

• Cardiovascular medicine
• Interventional cardiology
• Diagnostic imaging

Background:

• Myocardial ischemia requires clear demonstration before revascularization.
• Non-invasive tests for ischemia are not always performed or yield equivocal results.
• Coronary angiography visually assesses stenosis but not hemodynamic significance.

Purpose of the Study:

• To highlight the importance of hemodynamic assessment in coronary artery disease.
• To introduce fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) as key diagnostic tools.
• To discuss the role of coronary angiography and provocative testing for spastic angina.

Main Methods:

• Coronary angiography for visual stenosis evaluation.
• Measurement of coronary flow reserve using FFR and iFR for hemodynamic significance.
• Provocative methylergonovine test during angiography for suspected spastic angina.

Main Results:

• FFR and iFR provide a simple, invasive method to assess the hemodynamic impact of coronary lesions.
• These invasive measurements complement or clarify results from non-invasive testing.
• Angiography combined with functional testing confirms lesion significance and aids treatment decisions.

Conclusions:

• Hemodynamic assessment using FFR or iFR is crucial for guiding coronary revascularization decisions.
• Coronary angiography, while essential, requires functional assessment for definitive stenosis evaluation.
• Invasive physiological measurements improve the accuracy of diagnosing and managing coronary artery disease.