Coronary Functional Tests in the Catheterization Laboratory　– Pathophysiological and Clinical Relevance –

Abstract

Coronary angiography has long been the only diagnostic tool for the invasive assessment of coronary artery disease. Yet it does not allow establishing the functional severity of epicardial stenoses or vasomotor disorders of the epicardial arteries or coronary microcirculation. Functional tests in the catheterization laboratory have recently emerged as an important adjunct to coronary angiography for providing a comprehensive evaluation of the coronary circulation. In this review, we will describe and interpret the key functional tests used in current clinical practise in different clinical settings. (Circ J 2015; 79: 676 -684)

Endothelial Dysfunction and Pregnant COVID-19 Patients with Thrombophilia: A Narrative Review

“…The intracoronary acetylcholine provocation test is the gold standard for vasoreactivity testing [ 16 ]. Acetylcholine binds muscarinic receptors, which leads to nitric oxide (NO) release and subsequent arterial dilatation in the case of an intact endothelium.…”

Imaging Assessment of Endothelial Function: An Index of Cardiovascular Health

“…At higher doses, acetylcholine can result in constriction of small arteries via direct effect on smooth muscle cells, and may be used to evaluate microvascular function (16). Less commonly, other agents used in endothelial-dependent vasomotor testing have included bradykinin, papaverine and Substance P (17). In addition, adenosine has partial endothelial dependent effects (18).…”

“…Coronary microvascular function can be studied invasively by measuring coronary blood flow changes and thereby coronary flow reserve using a Doppler wire. Generally, this is accomplished by placement of a Doppler-tipped guide wire into the coronary artery of interest, whereby continuous blood flow velocity is measured both at baseline and during intracoronary infusion of vasoactive substances (acetylcholine, adenosine, or papaverine) through the guiding catheter (17,21,22).…”

“…These techniques have also been used in the assessment of endothelial dysfunction reversal with treatment therapies (28). The advantages of catheter-based methods of coronary endothelial assessment include the precision and accuracy of results obtained using this gold standard of testing, particularly in comparison to techniques that rely on surrogate measures of coronary arterial function (17). With this approach, however, come the limitations of an invasive procedure with intra-arterial injection of vasoactive medications that can have systemic adverse effects, along with exposure to radiation and contrast.…”

Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization

“…CFR and microvascular resistance can be measured using a pressure-and flow-sensitive Doppler catheter or a thermodilution guidewire. These techniques can be performed during coronary angiography enabling a comprehensive assessment of CMD by assessing microvascular dilatory function (59,60), which may complement coronary reactivity testing within the same procedure.…”