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Case Report: Invasive and Non-invasive Hemodynamic Assessment of Coronary Artery Disease: Strengths and Weaknesses
Ganesh Gajanan1, Saurabhi Samant1, Chad Hovseth1
1Cardiovascular Division, University of Nebraska Medical Center, Omaha, NE, United States.
Insights
Physiology-guided percutaneous coronary interventions (PCI) improve outcomes for coronary artery disease (CAD). New non-invasive and angiography-derived methods offer reliable alternatives for hemodynamic assessment, enhancing patient care.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Coronary angiography is the standard for assessing coronary artery disease (CAD) and guiding percutaneous coronary interventions (PCI).
- Physiology-guided PCI demonstrates improved safety, efficacy, resource use, and clinical outcomes in stable angina and acute coronary syndromes.
Observation:
- This report details three cases, highlighting the pros and cons of current invasive and non-invasive physiological assessment methods for CAD.
- Technological advancements are introducing new modalities for hemodynamic assessment.
Findings:
- Invasive non-wire-based (angiography-derived fractional flow reserve) and non-invasive (FFRCT) techniques are emerging as reliable and user-friendly alternatives to traditional wire-based fractional flow reserve (FFR).
- These advanced methods provide accurate hemodynamic assessment of CAD.
Implications:
- Interventional cardiologists and cardiovascular providers need to understand the capabilities and limitations of these evolving hemodynamic assessment tools.
- Adoption of these technologies can lead to more precise CAD management and potentially better patient outcomes.
Abstract:
Coronary angiography has been the gold standard for assessment of coronary artery disease (CAD) and guidance for percutaneous coronary interventions (PCI). Physiology-guided PCI has shown increased safety and efficacy, improved resource utilization, and better clinical outcomes in patients with stable angina and acute coronary syndromes. The three cases presented and discussed in this report illustrate the strengths and weaknesses of the available invasive and non-invasive methods for the physiological assessment of CAD. As technology evolves, invasive non-wire-based (angiography-derived FFR) and non-invasive (FFRCT) modalities for the hemodynamic assessment of CAD appear to provide reliable and user-friendly alternatives to the gold standard invasive wire-based techniques. Interventional cardiologists and cardiovascular healthcare providers should be familiar with the strengths and weaknesses of the available hemodynamic assessment modalities.
