Physiological assessment of coronary lesion severity

Robertson, K. E., Hennigan, B., Berry, C. and Oldroyd, K. G. (2015) Physiological assessment of coronary lesion severity. Coronary Artery Disease, 26, e8-e14. (doi: 10.1097/MCA.0000000000000212) (PMID:26247276)

Full text not currently available from Enlighten.

Abstract

Coronary angiography alone cannot accurately identify the haemodynamic impact of a coronary artery stenosis. Current international guidelines for myocardial revascularization recommend that inducible ischaemia should be demonstrated before the consideration of percutaneous coronary intervention. Invasive physiological assessment of coronary stenosis severity has increasingly been utilized for this purpose and use of the best validated technique, fractional flow reserve (FFR), has been shown to improve clinical outcomes in patients with stable and unstable coronary artery disease. This has led to the use of FFR being recommended in international revascularization guidelines, despite which, clinical uptake has been limited. One potential reason for slow adoption has been the requirement for maximal hyperaemia at the time of FFR measurement, usually achieved by the administration of pharmacological vasodilators such as adenosine. In some healthcare systems, adenosine is expensive and, in addition, its use can be associated with significant, albeit transient, adverse effects that patients (and some operators) find uncomfortable. Consequently, several methods of nonhyperaemic lesion assessment and their potential role in decision making have been reported. In this review we will review and discuss the current evidence for hyperaemic and nonhyperaemic methods of lesion assessment. We will also look at hybrid strategies that utilize both hyperaemic and nonhyperaemic methods as a means of potentially maintaining diagnostic accuracy while minimizing the requirement for adenosine administration and discuss whether or not they represent viable clinical alternatives.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Oldroyd, Dr Keith and Robertson, Dr Keith and Hennigan, Dr Barry
Authors: Robertson, K. E., Hennigan, B., Berry, C., and Oldroyd, K. G.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Coronary Artery Disease
Publisher:Lippincott, Williams and Wilkins
ISSN:0954-6928
ISSN (Online):1473-5830

University Staff: Request a correction | Enlighten Editors: Update this record