Serial stenosis assessment—can we rely on invasive coronary physiology
Atherosclerosis is a widespread disease affecting coronary arteries. Diffuse atherosclerotic disease affects the whole vessel, posing difficulties in determining lesion significance by angiography. Research has confirmed that revascularization guided by invasive coronary physiology indices improves...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1172906/full |
| _version_ | 1797835581292544000 |
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| author | Ivan Ilic Ivan Ilic Stefan Timcic Natalija Odanovic Petar Otasevic Petar Otasevic Carlos Collet |
| author_facet | Ivan Ilic Ivan Ilic Stefan Timcic Natalija Odanovic Petar Otasevic Petar Otasevic Carlos Collet |
| author_sort | Ivan Ilic |
| collection | DOAJ |
| description | Atherosclerosis is a widespread disease affecting coronary arteries. Diffuse atherosclerotic disease affects the whole vessel, posing difficulties in determining lesion significance by angiography. Research has confirmed that revascularization guided by invasive coronary physiology indices improves patients' prognosis and quality of life. Serial lesions can be a diagnostic challenge because the measurement of functional stenosis significance using invasive physiology is influenced by a complex interplay of factors. The use of fractional flow reserve (FFR) pullback provides a trans-stenotic pressure gradient (ΔP) for each of the lesions. The strategy of treating the lesion with greater ΔP first and then reevaluating another lesion has been advocated. Similarly, non-hyperemic indices can be used to assess the contribution of each stenosis and predict the effect of lesion treatment on physiology indices. Pullback pressure gradient (PPG) integrates physiological variables of coronary pressure along the epicardial vessel and characteristics of discrete and diffuse coronary stenoses into a quantitative index that can be used to guide revascularization. We proposed an algorithm that integrates FFR pullbacks and calculates PPG to determine individual lesion importance and to guide intervention. Computer modeling of the coronaries and the use of non-invasive FFR measurement together with mathematical algorithms for fluid dynamics can make predictions of lesion significance in serial stenoses easier and provide practical solutions for treatment. All these strategies need to be validated before widespread clinical use. |
| first_indexed | 2024-04-09T14:55:59Z |
| format | Article |
| id | doaj.art-03ba61345eef414e90e59cb78b221182 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-09T14:55:59Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-03ba61345eef414e90e59cb78b2211822023-05-02T05:08:06ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-05-011010.3389/fcvm.2023.11729061172906Serial stenosis assessment—can we rely on invasive coronary physiologyIvan Ilic0Ivan Ilic1Stefan Timcic2Natalija Odanovic3Petar Otasevic4Petar Otasevic5Carlos Collet6Institute for Cardiovascular Diseases Dedinje, Belgrade, SerbiaMedical School, University of Belgrade, Belgrade, SerbiaInstitute for Cardiovascular Diseases Dedinje, Belgrade, SerbiaInstitute for Cardiovascular Diseases Dedinje, Belgrade, SerbiaInstitute for Cardiovascular Diseases Dedinje, Belgrade, SerbiaMedical School, University of Belgrade, Belgrade, SerbiaCardiovascular Center Aalst, OLV Clinic, Aalst, BelgiumAtherosclerosis is a widespread disease affecting coronary arteries. Diffuse atherosclerotic disease affects the whole vessel, posing difficulties in determining lesion significance by angiography. Research has confirmed that revascularization guided by invasive coronary physiology indices improves patients' prognosis and quality of life. Serial lesions can be a diagnostic challenge because the measurement of functional stenosis significance using invasive physiology is influenced by a complex interplay of factors. The use of fractional flow reserve (FFR) pullback provides a trans-stenotic pressure gradient (ΔP) for each of the lesions. The strategy of treating the lesion with greater ΔP first and then reevaluating another lesion has been advocated. Similarly, non-hyperemic indices can be used to assess the contribution of each stenosis and predict the effect of lesion treatment on physiology indices. Pullback pressure gradient (PPG) integrates physiological variables of coronary pressure along the epicardial vessel and characteristics of discrete and diffuse coronary stenoses into a quantitative index that can be used to guide revascularization. We proposed an algorithm that integrates FFR pullbacks and calculates PPG to determine individual lesion importance and to guide intervention. Computer modeling of the coronaries and the use of non-invasive FFR measurement together with mathematical algorithms for fluid dynamics can make predictions of lesion significance in serial stenoses easier and provide practical solutions for treatment. All these strategies need to be validated before widespread clinical use.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1172906/fullcoronary artery stenosisfractional flow reserve (FFR)pullback pressure gradientIFRserial stenosis |
| spellingShingle | Ivan Ilic Ivan Ilic Stefan Timcic Natalija Odanovic Petar Otasevic Petar Otasevic Carlos Collet Serial stenosis assessment—can we rely on invasive coronary physiology Frontiers in Cardiovascular Medicine coronary artery stenosis fractional flow reserve (FFR) pullback pressure gradient IFR serial stenosis |
| title | Serial stenosis assessment—can we rely on invasive coronary physiology |
| title_full | Serial stenosis assessment—can we rely on invasive coronary physiology |
| title_fullStr | Serial stenosis assessment—can we rely on invasive coronary physiology |
| title_full_unstemmed | Serial stenosis assessment—can we rely on invasive coronary physiology |
| title_short | Serial stenosis assessment—can we rely on invasive coronary physiology |
| title_sort | serial stenosis assessment can we rely on invasive coronary physiology |
| topic | coronary artery stenosis fractional flow reserve (FFR) pullback pressure gradient IFR serial stenosis |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1172906/full |
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