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Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion: Implications of FFR as an Imperfect Reference Standard for Myocardial Ischemia

PURPOSE OF REVIEW: Accumulating evidence exists for the value of coronary physiology for clinical decision-making in ischemic heart disease (IHD). The most frequently used pressure-derived index to assess stenosis severity, the fractional flow reserve (FFR), has long been considered the gold standar...

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Autores principales: Stegehuis, Valérie E., Wijntjens, Gilbert W., Piek, Jan J., van de Hoef, Tim P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061210/
https://www.ncbi.nlm.nih.gov/pubmed/30046914
http://dx.doi.org/10.1007/s11886-018-1017-4
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author Stegehuis, Valérie E.
Wijntjens, Gilbert W.
Piek, Jan J.
van de Hoef, Tim P.
author_facet Stegehuis, Valérie E.
Wijntjens, Gilbert W.
Piek, Jan J.
van de Hoef, Tim P.
author_sort Stegehuis, Valérie E.
collection PubMed
description PURPOSE OF REVIEW: Accumulating evidence exists for the value of coronary physiology for clinical decision-making in ischemic heart disease (IHD). The most frequently used pressure-derived index to assess stenosis severity, the fractional flow reserve (FFR), has long been considered the gold standard for this purpose, despite the fact that the FFR assesses solely epicardial stenosis severity and aims to estimate coronary flow impairment in the coronary circulation. The coronary flow reserve (CFR) directly assesses coronary blood flow in the coronary circulation, including both the epicardial coronary artery and the coronary microvasculature, but is nowadays less established than FFR. It is now recognized that both tools may provide insight into the pathophysiological substrate of ischemic heart disease, and that particularly combined FFR and CFR measurements provide a comprehensive insight into the multilevel involvement of IHD. This review discusses the diagnostic and prognostic characteristics, as well as future implications of combined assessment of FFR and CFR pressure and flow measurements as parameters for inducible ischemia. RECENT FINDINGS: FFR and CFR disagree in up to 40% of all cases, giving rise to fundamental questions regarding the role of FFR in contemporary ischemic heart disease management, and implying a renewed approach in clinical management of these patients using combined coronary pressure and flow measurement to allow appropriate identification of patients at risk for cardiovascular events. SUMMARY: This review emphasizes the value of comprehensive coronary physiology measurements in assessing the pathophysiological substrate of IHD, and the importance of acknowledging the broad spectrum of epicardial and microcirculatory involvement in IHD. Increasing interest and large clinical trials are expected to further strengthen the potential of advanced coronary physiology in interventional cardiology, consequently inducing reconsideration of current clinical guidelines.
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spelling pubmed-60612102018-08-09 Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion: Implications of FFR as an Imperfect Reference Standard for Myocardial Ischemia Stegehuis, Valérie E. Wijntjens, Gilbert W. Piek, Jan J. van de Hoef, Tim P. Curr Cardiol Rep Nuclear Cardiology (V Dilsizian, Section Editor) PURPOSE OF REVIEW: Accumulating evidence exists for the value of coronary physiology for clinical decision-making in ischemic heart disease (IHD). The most frequently used pressure-derived index to assess stenosis severity, the fractional flow reserve (FFR), has long been considered the gold standard for this purpose, despite the fact that the FFR assesses solely epicardial stenosis severity and aims to estimate coronary flow impairment in the coronary circulation. The coronary flow reserve (CFR) directly assesses coronary blood flow in the coronary circulation, including both the epicardial coronary artery and the coronary microvasculature, but is nowadays less established than FFR. It is now recognized that both tools may provide insight into the pathophysiological substrate of ischemic heart disease, and that particularly combined FFR and CFR measurements provide a comprehensive insight into the multilevel involvement of IHD. This review discusses the diagnostic and prognostic characteristics, as well as future implications of combined assessment of FFR and CFR pressure and flow measurements as parameters for inducible ischemia. RECENT FINDINGS: FFR and CFR disagree in up to 40% of all cases, giving rise to fundamental questions regarding the role of FFR in contemporary ischemic heart disease management, and implying a renewed approach in clinical management of these patients using combined coronary pressure and flow measurement to allow appropriate identification of patients at risk for cardiovascular events. SUMMARY: This review emphasizes the value of comprehensive coronary physiology measurements in assessing the pathophysiological substrate of IHD, and the importance of acknowledging the broad spectrum of epicardial and microcirculatory involvement in IHD. Increasing interest and large clinical trials are expected to further strengthen the potential of advanced coronary physiology in interventional cardiology, consequently inducing reconsideration of current clinical guidelines. Springer US 2018-07-26 2018 /pmc/articles/PMC6061210/ /pubmed/30046914 http://dx.doi.org/10.1007/s11886-018-1017-4 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Nuclear Cardiology (V Dilsizian, Section Editor)
Stegehuis, Valérie E.
Wijntjens, Gilbert W.
Piek, Jan J.
van de Hoef, Tim P.
Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion: Implications of FFR as an Imperfect Reference Standard for Myocardial Ischemia
title Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion: Implications of FFR as an Imperfect Reference Standard for Myocardial Ischemia
title_full Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion: Implications of FFR as an Imperfect Reference Standard for Myocardial Ischemia
title_fullStr Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion: Implications of FFR as an Imperfect Reference Standard for Myocardial Ischemia
title_full_unstemmed Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion: Implications of FFR as an Imperfect Reference Standard for Myocardial Ischemia
title_short Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion: Implications of FFR as an Imperfect Reference Standard for Myocardial Ischemia
title_sort fractional flow reserve or coronary flow reserve for the assessment of myocardial perfusion: implications of ffr as an imperfect reference standard for myocardial ischemia
topic Nuclear Cardiology (V Dilsizian, Section Editor)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061210/
https://www.ncbi.nlm.nih.gov/pubmed/30046914
http://dx.doi.org/10.1007/s11886-018-1017-4
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