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Comprehensive Assessment of the Coronary Circulation Using Pressure and Flow Measurements

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Physiological Assessment of Coronary Stenoses and the Microcirculation

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Abstract

While fractional flow reserve has greatly contributed to the clinical applicability of ischemia-driven revascularization, it cannot provide information on whether other realms of the coronary circulation, which also cause myocardial ischemia, such as the microvasculature, are affected. A growing body of evidence suggests that the combined use of coronary flow reserve and fractional flow reserve can provide a much richer view of the status the coronary circulation. Such multimodal physiological assessment of the coronary circulation can be further enriched with the incorporation of measurements of resistance derived from thermodilution or Doppler flow velocity and intracoronary pressure. In this chapter we review the rationale for and available evidence on multimodal coronary physiology, providing examples of its applicability in the clinical field.

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    Authors and Affiliations

    1. Hospital Clínico San Carlos, Madrid, Spain

      Hernan Mejia-Rentería MD, Nicola Ryan MB, BCh, Fernando Macayo MD, Ivan Nuñéz-Gil MD PhD, Luis Nombela-Franco MD, PhD & Javier Escaned MD, PhD

    2. Interventional Cardiology Unit, Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain

      Javier Escaned MD, PhD

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    1. Hernan Mejia-Rentería MD
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    2. Nicola Ryan MB, BCh
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    3. Fernando Macayo MD
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    5. Luis Nombela-Franco MD, PhD
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    6. Javier Escaned MD, PhD
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    Editors and Affiliations

    1. Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain

      Javier Escaned

    2. Imperial College London, London, United Kingdom

      Justin Davies

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    Mejia-Rentería, H., Ryan, N., Macayo, F., Nuñéz-Gil, I., Nombela-Franco, L., Escaned, J. (2017). Comprehensive Assessment of the Coronary Circulation Using Pressure and Flow Measurements. In: Escaned, J., Davies, J. (eds) Physiological Assessment of Coronary Stenoses and the Microcirculation. Springer, London. https://doi.org/10.1007/978-1-4471-5245-3_18

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    • DOI: https://doi.org/10.1007/978-1-4471-5245-3_18

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    • Print ISBN: 978-1-4471-5244-6

    • Online ISBN: 978-1-4471-5245-3

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