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Physiologic Lesion Assessment: Fractional Flow Reserve

  • Mohammad Sahebjalal
  • Nicholas Curzen
Chapter

Abstract

Patient outcome following percutaneous coronary intervention (PCI) is predominantly determined by three factors: clinical presentation, comorbidities, and decision-making process before, during, and after the PCI procedure. In order to justify any intervention, there needs to be reason to think that this will result in either (a) an improvement of symptoms, or (b) an improvement in prognosis, or (c) both. For the interventionalist, the skillful application of modern diagnostic tools and reference to the appropriate evidence base can facilitate delivery of optimal patient care. Coronary angiography has been used as a diagnostic tool for more than half a century. However, it is now well established that coronary angiography alone has important flaws and, in particular, can correlate poorly with the functional importance of a stenosis within the epicardial arteries. Further, the evidence base increasingly points to lesion-level ischemia as our target for revascularization. The availability of invasive physiological lesion assessment has revolutionized our ability to define with precision the presence or absence of lesion-level ischemia. The aim of this chapter is to review the evidence for and the expanding role of physiological lesion assessment in our everyday interventional practice.

Keywords

Coronary blood flow Perfusion pressure Coronary flow reserve Index of microvascular resistance Fractional flow reserve Pressure wire Maximal hyperemia Serial stenoses 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Coronary Research GroupUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
  2. 2.Faculty of MedicineUniversity of SouthamptonSouthamptonUK

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