Agreement between coronary flow velocity reserve and stress echocardiography in intermediate-severity coronary stenoses

Intracoronary pressure and flow velocity for hemodynamic evaluation of coronary stenoses

Adequate patient selection for percutaneous coronary intervention is of utmost importance to minimize early and late complications. Consequently, objective evidence for myocardial ischemia is mandatory for the management of patients with coronary artery disease, in particular in multivessel disease and intermediate lesions (40-70% diameter stenosis on angiography). The use of sensor-equipped guide wires for the assessment of functional coronary lesion severity has become widespread in the catheterization laboratory. The indices derived from pressure or flow measurements, fractional flow reserve, coronary flow velocity reserve and relative coronary flow velocity reserve show a high agreement with noninvasive stress testing. However, while these indices are based on either intracoronary pressure or flow, they do not investigate the hemodynamics of the coronary circulation entirely, leading to ambiguous outcomes. Only the use of simultaneously measured pressure and flow will avoid any possible misinterpretation of the data.

Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology

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.

Evaluación y guía terapéutica de las lesiones coronarias intermedias en el laboratorio de hemodinámica

Contrast angiography has been used for nearly five decades to evaluate the severity of coronary lesions. However, when attempting to distinguish between intermediate coronary lesions able or unable to produce ischemia, the technique has several limitations. A large number of patients undergo cardiac catheterization without prior evaluation of coronary perfusion by non-invasive tests. This number is likely to increase in the coming years, because current recommendations favor the invasive treatment of acute coronary syndromes. This has triggered marked interest in new diagnostic techniques capable of assessing the physiological significance of intermediate lesions in the catheterization room. This paper reviews the different techniques currently available for scientifically assessing the significance of such lesions. The advantages and limitations of each are discussed.