In recent years, more than 10 invasive and noninvasive modalities are now available for coronary physiological assessment and physiology-based decision-making in patients with coronary artery disease (CAD). Pressure-derived fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are now standard methods for identifying functionally significant coronary stenoses and guiding coronary revascularization. Recently, other commercially available resting non-hyperemic pressure ratios (NHPRs) including diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR) have been introduced to assess the functional significance of epicardial coronary stenosis. All resting NHPRs (iFR, RFR, and dPR) closely correlated with each other and showed excellent agreement and the same diagnostic performance was comparable when the other references were used to define the presence of myocardial ischemia. However, FFR and resting NHPRs did not always show concordant results for decision-making in clinical practice.
This discordance phenomenon can be influenced by various factors originating from patient comorbidities (cardiomyopathies, valvular heart disease, etc), lesion characteristics, and reduced vasodilatory capacity of microcirculation defined as coronary microvascular dysfunction (CMD). CMD occurs as a consequence of structural and/or functional abnormalities in coronary microcirculation and is prevalent across different cardiovascular diseases. It is associated with the presence of ischemia and worse outcomes even in the absence of CAD. Therefore, understanding the interplay between CMD, CAD, and different comorbidities is crucial to correctly interpret the results obtained with different invasive and noninvasive physiological indices.
This Research Topic will focus on challenges, limitations, and future perspectives in the functional assessment of coronary stenosis severity and the presence of CMD using different invasive and noninvasive physiological indices. Non-invasive methods may include CT-FFR, vFFR, ca-FFR, QFR.
In recent years, more than 10 invasive and noninvasive modalities are now available for coronary physiological assessment and physiology-based decision-making in patients with coronary artery disease (CAD). Pressure-derived fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are now standard methods for identifying functionally significant coronary stenoses and guiding coronary revascularization. Recently, other commercially available resting non-hyperemic pressure ratios (NHPRs) including diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR) have been introduced to assess the functional significance of epicardial coronary stenosis. All resting NHPRs (iFR, RFR, and dPR) closely correlated with each other and showed excellent agreement and the same diagnostic performance was comparable when the other references were used to define the presence of myocardial ischemia. However, FFR and resting NHPRs did not always show concordant results for decision-making in clinical practice.
This discordance phenomenon can be influenced by various factors originating from patient comorbidities (cardiomyopathies, valvular heart disease, etc), lesion characteristics, and reduced vasodilatory capacity of microcirculation defined as coronary microvascular dysfunction (CMD). CMD occurs as a consequence of structural and/or functional abnormalities in coronary microcirculation and is prevalent across different cardiovascular diseases. It is associated with the presence of ischemia and worse outcomes even in the absence of CAD. Therefore, understanding the interplay between CMD, CAD, and different comorbidities is crucial to correctly interpret the results obtained with different invasive and noninvasive physiological indices.
This Research Topic will focus on challenges, limitations, and future perspectives in the functional assessment of coronary stenosis severity and the presence of CMD using different invasive and noninvasive physiological indices. Non-invasive methods may include CT-FFR, vFFR, ca-FFR, QFR.