[Coronary disease: should images be treated?]

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Diagnostics

Background:

• Coronarography and angioscopy provide detailed anatomical views of coronary artery stenosis, revealing plaque characteristics and pathophysiological mechanisms.
• Endocoronary echography offers histological-like views of the artery wall layers without biopsy, enhancing understanding of stenosis.
• Current imaging excels at anatomical detail but requires functional assessment for comprehensive diagnosis.

Discussion:

• Anatomical imaging alone is insufficient for therapeutic decisions; functional assessment of coronary circulation is crucial.
• Measuring coronary artery flow velocity and pressure across stenoses provides critical data on the impact of disease.
• Integrating anatomical and functional imaging provides a holistic view of coronary artery disease.

Key Insights:

• Doppler signals from a catheter-tip sensor quantify blood flow velocity, revealing diastolic/systolic patterns and coronary vascular reserve.
• Transstenotic pressure measurements complement flow data, offering a complete hemodynamic assessment.
• Therapeutic strategies should be guided by both precise anatomical visualization and functional flow dynamics.

Outlook:

• Optimizing current imaging techniques is essential for improving patient outcomes.
• Developing treatments with the best benefit-risk-cost ratio for coronary artery disease is a key goal.
• Future research should focus on refining integrated anatomical and functional imaging for personalized patient care.