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Intravascular Imaging versus Physiological Assessment versus Biomechanics-Which Is a Better Guide for Coronary

Miłosz Starczyński1, Stanisław Dudek1, Piotr Baruś1

  • 1First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland.

Diagnostics (Basel, Switzerland)
|June 28, 2023
PubMed

Insights

Assessing coronary artery disease (CAD) requires reliable stenosis evaluation. This review covers invasive imaging like optical coherence tomography (OCT) and intravascular ultrasound (IVUS), alongside advanced functional measures for improved CAD management.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Techniques

Background:

  • Coronary artery disease (CAD) remains a leading global cause of mortality.
  • Accurate assessment of coronary stenosis is crucial for effective CAD management.
  • Current diagnostic modalities for CAD face limitations in imaging and functional assessment.

Purpose of the Study:

  • To review current invasive functional and intracoronary imaging assessments for coronary stenosis.
  • To highlight novel angiography-based and hybrid approaches for CAD evaluation.

Main Methods:

  • Review of existing literature on invasive functional and intracoronary imaging techniques.
  • Summary of established methods like fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR).
  • Discussion of emerging techniques including optical coherence tomography (OCT), intravascular ultrasound (IVUS), quantitative flow ratio (QFR), FFR-CT, and computational fluid dynamics.

Main Results:

  • Invasive functional assessments like FFR and iFR are established tools.
  • Intracoronary imaging modalities such as OCT and IVUS provide detailed anatomical information.
  • Novel angiography-based measures (QFR, vFFR, FFRangio, FFR-CT) and hybrid approaches offer promising alternatives for stenosis assessment.

Conclusions:

  • Accurate stenosis assessment is vital for managing coronary artery disease.
  • A range of invasive functional and imaging techniques are available, each with strengths and limitations.
  • Emerging non-invasive and hybrid methods show potential to overcome current diagnostic challenges in CAD.

Keywords:
angiography-derived fractional flow reservecomputed tomography-derived flow fractional reservecoronary artery diseasefractional flow reserveinstantaneous wave-free ratiointravascular ultrasoundoptical coherence tomographyoptical flow ratiopercutaneous coronary interventionquantitative flow ratio

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