Fractional flow reserve: a review: invasive imaging.

Abstract

Coronary angiography remains far and away the most accurate morphologic assessment of the lumen of the epicardial coronary arteries. Although non-invasive imaging is rapidly advancing, the temporal and spatial resolution of coronary angiography is still unsurpassed and it will therefore remain as a roadmap for interventional cardiologists and cardiac surgeons. Most non-invasive cardiologists still consider a coronary angiogram as "invasive" (although this is a debatable classification in 2008), but welcome the high level of anatomical information. However, in contrast to its topographical precision, angiography is limited in gauging the functional repercussions of coronary stenoses. Yet, functional severity of atherosclerotic narrowings is the single most important prognostic factor in patients with documented coronary artery disease. This was recently highlighted in several large meta-analyses: the estimated annualised rate of myocardial infarction or cardiac death was approximately 0.5% per year after a normal myocardial perfusion imaging or a normal stress echocardiogram in patients . . .