The Pullback Pressure Gradient: Transforming Invasive Coronary Physiology from Lesion Assessment to Disease Pattern...

Area of Science:

• Interventional Cardiology
• Cardiovascular Physiology
• Medical Diagnostics

Background:

• Coronary artery disease (CAD) assessment traditionally focuses on individual stenoses.
• Existing physiological indices like FFR and iFR have limitations in characterizing diffuse disease.
• A need exists for a comprehensive method to evaluate longitudinal CAD distribution.

Purpose of the Study:

• To analyze the invasive pullback pressure gradient (PPG) as a novel physiological index for CAD.
• To explore PPG's role in guiding revascularization strategies and predicting outcomes.
• To elucidate PPG's mechanistic explanation for discordance between FFR and iFR.

Main Methods:

• Review of historical development from subjective analysis to quantitative PPG measurement.
• Description of procedural aspects for both manual and motorized PPG acquisition.
• Synthesis of evidence supporting PPG's clinical utility and predictive value.

Main Results:

• PPG assessment modified revascularization strategy in 14% of patients in the PPG Global Registry.
• PPG provides a mechanistic link between focal/diffuse CAD and FFR/iFR discordance patterns.
• Evidence supports PPG's utility in predicting post-PCI outcomes and improving patient-centered results.

Conclusions:

• PPG represents a significant advancement in coronary physiology, moving beyond individual stenoses to disease patterns.
• This physiological index enhances understanding of CAD pathophysiology and guides personalized revascularization.
• Prospective trials are needed to establish PPG as a cornerstone of interventional cardiology.