Related Experiment Video
Updated: Jun 18, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Coronary Physiology: Delivering Precision Medicine?
Laura Maitre-Ballesteros1, Laurent Riou2, Stephanie Marliere1
1Department of Cardiology, University Hospital, 38000 Grenoble Alpes, France.
Insights
Coronary physiological assessment, including fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), aids in managing coronary artery disease (CAD). These methods evaluate epicardial lesions and microcirculation for precision medicine in chronic coronary syndrome.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Physiology
Background:
- Coronary physiological assessment is crucial for evaluating epicardial coronary lesions.
- Fractional flow reserve (FFR) is the established gold standard for guiding revascularization decisions.
- Emerging indexes now allow for comprehensive assessment of both epicardial and microvascular coronary function.
Purpose of the Study:
- To review available epicardial and microvascular indexes for coronary physiological assessment.
- To discuss the demonstrated contributions of these indexes in managing coronary artery disease (CAD).
- To explore the potential role of coronary physiology in precision medicine, particularly for chronic coronary syndrome.
Main Methods:
- Review of clinical evidence and established guidelines on coronary physiological assessment.
- Analysis of current epicardial and microvascular indexes used in cardiac catheterization laboratories.
- Synthesis of data on the application of these indexes in patient management.
Main Results:
- Fractional flow reserve (FFR) remains the gold standard for epicardial lesion assessment.
- Indexes like instantaneous wave-free ratio (iFR) offer alternative approaches for revascularization decisions.
- Newer indexes enable detailed evaluation of coronary microcirculation, complementing epicardial assessment.
Conclusions:
- Coronary physiological assessment provides a comprehensive evaluation of the entire coronary tree.
- These assessments facilitate precision medicine strategies for patients with coronary artery disease (CAD).
- The application of these indexes is particularly relevant for optimizing the management of chronic coronary syndrome.
Abstract:
Coronary physiological assessment is now widely used to assess epicardial coronary lesions in cath lab. Based on clinical evidence, fractional flow reserve (FFR) is the gold standard method to select whether epicardial coronary lesions need revascularization. While additional epicardial indexes, such as instantaneous wave-free ratio (iFR), are also used for revascularization decision-making, several indexes are now also available to explore the coronary microcirculation. Therefore, coronary physiological assessment now allows to explore the entire coronary tree and offer the potential of precision medicine for patients affected by coronary artery disease (CAD). This paper will provide review of the epicardial and microvascular indexes available for the assessment of coronary physiology. More specifically, the already demonstrated contributions of these indexes in the management of CAD and the role they could play in precision medicine will be reviewed with special emphasis on chronic coronary syndrome.
Related Concept Videos
01:29Pathophysiology of Cardiac Performance
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...