Functional assessment of coronary stenosis: alternative hyperemic, nonhyperemic, and angiographic indexes

Area of Science:

• Cardiovascular medicine
• Interventional cardiology
• Physiology

Background:

• Functional assessment of coronary artery stenosis is crucial for guiding percutaneous coronary intervention (PCI).
• Pressure wire-derived fractional flow reserve (FFR) during pharmacologic hyperemia is the standard method.
• Limitations of current FFR assessment include hyperemic agent contraindications, adverse effects, and potential vessel injury from the pressure wire.

Purpose of the Study:

• To review and discuss alternative methods for assessing the functional significance of coronary artery stenoses.
• To explore techniques that overcome the limitations of traditional FFR measurement.
• To provide an overview of emerging and established alternative diagnostic tools for coronary artery disease.

Main Methods:

• Review of existing literature on coronary stenosis assessment techniques.
• Discussion of alternative hyperemic agents and their efficacy/safety profiles.
• Analysis of nonhyperemic pressure ratios (NHPRs) and their diagnostic value.
• Evaluation of angiography-based indices as functional assessment tools.

Main Results:

• Several alternative hyperemic agents exist, potentially offering improved safety profiles.
• Nonhyperemic pressure ratios provide valuable functional information without requiring induced hyperemia.
• Angiography-based indices offer non-invasive or minimally invasive functional assessment capabilities.
• These alternative methods aim to provide accurate stenosis assessment with reduced risks compared to standard FFR.

Conclusions:

• Alternative methods for assessing coronary stenosis significance are emerging and validated.
• These techniques offer promising solutions to the limitations associated with traditional FFR.
• Further research and clinical adoption of these alternatives can optimize the guidance of percutaneous coronary intervention.