Coronary Pressure and Flow for the Assessment of Coronary Artery Disease

Abstract

Coronary blood flow and pressure measurements across a stenotic coronary artery provide information on the ischemic potential of a specific lesion at the time of catheterization. Physiological assessment of coronary artery stenosis by fractional flow reserve (FFR) has become the gold standard for invasive assessment of myocardial ischemia. Its integration in the catheterization procedure as an adjunct to coronary angiography has made a significant impact on clinical decision making and outcomes for patients with intermediately severe single-vessel disease, multivessel disease, left main stenosis, diffuse disease, and bifurcation or ostial branch stenoses. The validation of FFR from several large randomized trials has led to favorable recommendations in guidelines for coronary revascularization, making it part of the standard of care for patients with multivessel coronary artery disease. This chapter reviews the concepts behind integrated coronary physiology and its clinical applications.