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Updated: Aug 9, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Coronary physiology in the catheterisation laboratory: an A to Z practical guide
Simone Fezzi1,2, Jiayue Huang1,3, Mattia Lunardi1,2
1The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland.
Insights
Coronary physiology, including fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), guides revascularization decisions to improve outcomes. New computational methods enhance accuracy and reduce risks, aiding personalized treatment in the catheterization lab.
Area of Science:
- Interventional Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) management relies heavily on invasive coronary angiography (ICA), which historically lacks functional significance assessment of stenoses.
- Wire-based invasive physiological assessments like fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) have improved clinical outcomes by guiding revascularization decisions.
- Despite evidence and guidelines, adoption of invasive physiology is limited by technical, economic, and operator-related barriers.
Purpose of the Study:
- To provide a practical A to Z guide for applying coronary physiology in the catheterization laboratory.
- To explore various coronary physiology methods, their limitations, and practical tips for use.
- To highlight recent advancements in image-based computational physiology and integrated imaging-physiology approaches for personalized PCI.
Main Methods:
- Review of invasive wire-based physiological methods (FFR, iFR).
- Introduction to novel coronary image-based computational physiology.
- Discussion on the integration of intracoronary imaging and physiology.
Main Results:
- Invasive physiology (FFR, iFR) improves clinical outcomes when guiding PCI.
- Computational physiology shows promise in accuracy, speed, cost-effectiveness, and reduced patient risk.
- Integrated imaging and physiology enable individualized PCI for complete ischemia relief.
Conclusions:
- Coronary physiology is crucial for optimizing revascularization in CAD.
- Advancements in computational and integrated approaches are overcoming previous adoption barriers.
- This guide offers practical insights for catheterization laboratory application of coronary physiology.
Abstract:
Coronary revascularisation, either percutaneous or surgical, aims to improve coronary flow and relieve myocardial ischaemia. The decision-making process in patients with coronary artery disease (CAD) remains largely based on invasive coronary angiography (ICA), even though until recently ICA could not assess the functional significance of coronary artery stenoses. Invasive wire-based approaches for physiological evaluations were developed to properly assess the ischaemic relevance of epicardial CAD. Fractional flow reserve (FFR) and later, instantaneous wave-free ratio (iFR), were shown to improve clinical outcomes in several patient subsets when used for coronary revascularisation guidance or deferral and for procedural optimisation of percutaneous coronary intervention (PCI) results. Despite accumulating evidence and positive guideline recommendations, the adoption of invasive physiology has remained quite low, mainly due to technical and economic issues as well as to operator-resistance to change. Coronary image-based computational physiology has been recently developed, with promising results in terms of accuracy and a reduction in computational time, costs, radiation exposure and risks for the patient. Lastly, the integration of intracoronary imaging and physiology allows for individualised PCI treatment, aiming at complete relief of ischaemia through optimised morpho-functional immediate procedural results. Instead of a conventional state-of-the-art review, this A to Z dictionary attempts to provide a practical guide for the application of coronary physiology in the catheterisation laboratory, exploring several methods, their pitfalls, and useful tips and tricks.
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