Abstract
Invasive coronary physiology has been applied since the early days of percutaneous transluminal coronary angioplasty, and has become a rapidly emerging field of research. Many physiology indices have been developed, tested in clinical studies, and are now applied in daily clinical practice. Recent clinical practice guidelines further support the use of advanced invasive physiology methods to optimise the diagnosis and treatment of patients with acute and chronic coronary syndromes. This article provides a succinct review of the history of invasive coronary physiology, the basic concepts of currently available physiological parameters, and will particularly highlight the Dutch contribution to this field of invasive coronary physiology.
Highlights
The presence of atherosclerotic narrowing disturbs the otherwise laminar flow inside a coronary artery
fractional flow reserve (FFR) is defined as the ratio between mean distal coronary pressure and mean proximal coronary pressure, measured during maximal vasodilatation induced by a pharmacological agent such as adenosine
FFR values lower than 0.75 were found to correspond well with non-invasive measures of myocardial ischaemia [10]. This 0.75 FFR threshold was evaluated in patients with stable ischaemic heart disease in the DEFER study, where deferral of percutaneous coronary intervention (PCI) in coronary stenosis with an FFR value of >0.75 was not associated with increased rates of adverse events compared with PCI in this lesion subset [11,12,13]
Summary
The presence of atherosclerotic narrowing disturbs the otherwise laminar flow inside a coronary artery. Coronary guidewires were developed that were equipped with either a pressure sensor or a Doppler flow velocity sensor to assess with high fidelity, for the first time in humans, the haemodynamic significance of coronary lesions [6,7,8]. This diagnostic armamentarium has since yielded a variety of physiological parameters that can be used to characterise the haemodynamic severity of a coronary stenosis, as well as the functional status of the coronary microcirculation. This review will describe the basic concepts of these parameters, and will highlight the Dutch
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