Contemporary Use of Coronary Physiology in Cardiology

Authors

Ayman Elbadawi
Ramy Sedhom
Mohamed Ghoweba
Abdelazeem Mohamed Etewa
Waleed Kayani
Faisal Rahman

Publication Date

12-1-2023

Journal

Cardiol Therapeutics

DOI

10.1007/s40119-023-00329-2

PMID

37668939

PMCID

PMC10703757

PubMedCentral® Posted Date

9-5-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Acute coronary syndrome, Aortic stenosis, Coronary physiology, FFR, Heart failure, iFR, Post-PCI, Serial stenosis

Abstract

Coronary angiography has a limited ability to predict the functional significance of intermediate coronary lesions. Hence, physiological assessment of coronary lesions, via fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), has been introduced to determine their functional significance. An accumulating body of evidence has consolidated the role of physiology-guided revascularization, particularly among patients with stable ischemic heart disease. The use of FFR or iFR to guide decision-making in patients with stable ischemic heart disease and intermediate coronary lesions received a class I recommendation from major societal guidelines. Nevertheless, the role of coronary physiology testing is less clear among certain patients' groups, including patients with serial coronary lesions, acute coronary syndromes, aortic stenosis, heart failure, as well as post-percutaneous coronary interventions. In this review, we aimed to discuss the utility and clinical evidence of coronary physiology (mainly FFR and iFR), with emphasis on those specific patient groups.