Assessing Coronary Artery Physiology to Guide Decision Making in Coronary Artery Disease: From Pressure Wires to Non-invasive Imaging

Articles in Press

Document Type : Review Article

Authors

1 118 port said road, camp ceasaer

2 Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Abstract

Accurate determination of the functional significance of coronary stenoses can optimize treatment decisions and improve outcomes for patients with coronary artery disease (CAD). This review provides a comprehensive analysis of the capabilities, limitations, and evolving role of invasive and non-invasive techniques for physiological stenosis evaluation. Established modalities such as fractional flow reserve (FFR) and instant wave-free ratio (iFR) measured by pressure wires are discussed, along with emerging non-hyperemic indices and image-based computational physiology solutions.

Specific topics reviewed in detail include the fundamental principles of physiological assessment using different modalities, comparative diagnostic accuracy data from clinical studies, strengths and weaknesses of different modalities, practical integration to guide revascularization procedures, applications in multivessel disease, and post-PCI optimization, as well as limitations in certain clinical subsets. Furthermore, areas of active research and advancement are highlighted, such as machine learning accelerated computation of FFR and virtual stenting models from coronary imaging.

Continued unmet needs include optimal integration with emerging plaque characterization techniques, large-scale validation of CT and angiography-derived indices, appropriate use criteria development, and clinical pathways supporting dissemination. As technologies and evidence evolve, opportunities exist to match personalized assessment strategies to CAD phenotypic diversity for gains in risk stratification, therapeutic selectivity, and ultimately patient outcomes.

Keywords

Cardiovascular Research Prove Journal

Articles in Press, Accepted Manuscript
Available Online from 06 February 2024

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