Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory

Abstract

Abstract-With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care.

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

“…1 Abnormal CFR is often present in patients with essential hypertension despite the presence of angiographically normal coronary arteries and even in the absence of left ventricular (LV) hypertrophy. 2,3 Direct measurement of intracoronary flow velocity by using a Doppler guidewire constitutes the most reliable, though invasive, method for the evaluation of CFR.…”

Long-term prognostic value of CFVR and FFR versus perfusion scintigraphy in patients with multivessel disease

“…11 FFR was computed as the ratio of distal/aortic pressure during hyperaemia; FFR ≥0.75 was considered 'negative'. 2 …”

“…Assessment can be performed noninvasively (using myocardial perfusion scintigraphy; MPS) 1 or invasively during cardiac catheterisation using intracoronary derived haemodynamic indices. 2 Previous validation studies have shown good agreement (80 to 90%) between these parameters and the results of noninvasive stress tests. [3][4][5] Previously, we reported the final results of the ILIAS (Intermediate Lesions: Intracoronary flow Assessment versus 99m Tc-MIBI SPECT) study with one-year clinical follow-up.…”

“…Numerous studies have shown that deferral of PTCA is safe based on normal values of CFVR and/or FFR. 2 However, only a few other studies have addressed the value of CFVR and FFR with respect to long-term follow-up (i.e. more than one year), none of them in direct comparison with noninvasive assessment of myocardial ischaemia.…”

The endothelial cell in health and disease: its function, dysfunction, measurement and therapy

“…Coronary vasodilatory reserve (or coronary flow reserve) is the ratio of hyperemic to basal average peak flow velocity. 57 Hyperemia is typically achieved with intracoronary adenosine, which dilates the microvasculature and is partially endothelial dependent. 35 Coronary vasodilatory reserve is commonly used for patients with coronary artery disease to evaluate the physiological significance of intermediate severity stenoses, serial stenoses and other lesions of unclear significance.…”