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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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The new role of diagnostic angiography in coronary physiological assessment

Mina Ghobrial1, Hazel Arfah Haley1, Rebecca Gosling1,2

  • 1Mathematical Modellling in Medicine, Department of Infection Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, UK.

Heart (British Cardiac Society)
|January 9, 2021
PubMed

Insights

Coronary angiography (CAG) can now provide functional assessments like fractional flow reserve (FFR) using computational fluid dynamics. This integrated approach enhances diagnosis for chronic coronary syndromes, potentially reducing the need for additional tests.

Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Computational Fluid Dynamics

Background:

  • The role of stand-alone coronary angiography (CAG) in managing chronic coronary syndromes is debated, with CT angiography and interventional lab confinement as alternatives.
  • CAG remains the standard diagnostic tool in many healthcare settings for evaluating coronary artery disease.

Purpose of the Study:

  • To evaluate the integration of computational fluid dynamics with CAG for functional assessment of coronary artery disease.
  • To explore the potential of angiographically derived fractional flow reserve (CAG-FFR) in routine diagnostic workups, particularly in non-interventional settings.

Main Methods:

  • Application of computational fluid dynamics principles to angiographic images to derive virtual measures of blood flow.
  • Calculation of angiographically derived fractional flow reserve (CAG-FFR) from standard CAG data.
  • Analysis of the reliability, limitations, and integration of CAG-FFR within current clinical guidelines.

Main Results:

  • CAG combined with computational methods offers an 'all-in-one' anatomical and functional investigation.
  • This technology provides increased precision for borderline lesions and can reduce the need for further non-invasive ischemia tests.
  • CAG-FFR presents a cost-effective addition to diagnostic value.

Conclusions:

  • Angiographically derived fractional flow reserve (CAG-FFR) has the potential to become a standard part of the diagnostic workup for suspected coronary artery disease.
  • This technology can enhance the diagnostic capabilities of CAG, especially in non-interventional scenarios.
  • The assessment of coronary physiology may expand beyond the traditional role of the interventional cardiologist.

Keywords:
cardiac catheterisationcomputed tomography angiographycoronary angiographycoronary artery disease

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