Assessing Coronary Blood Flow Physiology in the Cardiac Catheterisation Laboratory

Abstract

Background:Contemporary management of coronary disease focuses on the treatment of stenoses in the major epicardial vessels. However, myocardial blood flow is known to be contingent on a range of factors in addition to the patency of the epicardial vessels. These include anatomical and physiological factors such as the extent of myocardium supplied by the vessel, systemic blood pres-sure, the natural variation in vascular tone in response to physiological needs which allows for coro-nary autoregulation and pathological factors such as the presence of downstream obstruction to flow due to disease of the small coronary vessels or myocardium. The assessment of clinical effectiveness and adequacy of coronary revascularisation requires the ability to comprehensively and accurately as-sess and measure myocardial perfusion.Conclusion:In this article, we review the current methods of evaluating coronary blood flow and my-ocardial perfusion in the cardiac catheterisation laboratory.

Relationship Between Plasma Total Homocysteine Levels and Mean Corrected TIMI Frame Count in Patients with Acute Myocardial Infarction

“…5 Corrected TIMI frame count (CTFC) is an angiographic argument that can re-stratify the risk of patients with post-procedural thrombolysis in myocardial infarction (TIMI) grade III flow and reflect the existence of SCF and CMD. 6,7 Homocysteine is a sulfur-containing amino acid that functions as a key intermediate in methionine metabolism and hyperhomocysteinemia (HHcy) is well established risk factor for cardiovascular disease. 8 Angiographic findings [9][10][11][12][13][14][15][16] found that patients with SCF had significantly higher plasma total homocysteine (tHcy) levels than those with normal coronary flow and HHcy was strongly correlated with SCF phenomenon in patients without organic coronary stenosis.…”

The relationship between microvascular angina and De Ritis ratio in normal coronary artery patients with recurrent chest pain / De Ritis ratio and microvascular angina

“…Echocardiography, stress test, myocardial perfusion scintigraphy, conventional angio and CT angio are the methods that can be used in diagnosis. The preferred method today is standard angiography but lack of information about the coronary microvascular bed is one of the limitations of it 11 . Considering that one third of the patients with normal coronary arteries had decrease in the coronary artery reserve and this group had microvascular angina, it is understood that this limitation may have striking results.…”

The Importance of Measuring Coronary Blood Flow for Clinical Decision Making

“…We read with interest the review by Vijayan, et al [ 2 ] on the assessment of coronary blood flow physiology in the cardiac catheterization laboratory [ 2 ]. This paper covers the major surrogate measures of coronary physiology, as well as the invasive and non-invasive methods of coronary flow quantification.…”

“…in 1972, [ 7 ] and popularized by the work of Gould, et al on coronary flow reserve and resistance [ 8 ]. Notably, Vijayan, et al [ 2 ] highlighted the advantages, disadvantages, and limitations of each approach to assessing coronary blood flow. Their analysis of the nuanced differences between the indices lends to an informed discussion on the subsequent implications for clinical practice.…”

“…Vijayan, et al [ 2 ] should be congratulated for their efforts in elegantly summarizing the complex topic of coronary blood flow assessment that will help physicians and specialists to apply a combination of these indices tailored to individual patients for clinical decision making. Their review also stimulates research on the development of novel tools for absolute coronary blood flow measurements in the catheterization laboratory, and highlights the importance of validating new techniques in larger series for the improvement of patient outcomes.…”