Current status and future expectations of the flow velocity guidewire
Coronary angiography incompletely delineates the physiologic consequences of many epicardial stenoses and is unable to diagnose microvascular abnormalities. Intracoronary flow velocity measurements with the Doppler guidewire contribute physiologic data regarding the hemodynamic significance of coronary stenoses and the functional capacity of the coronary microvasculature. Flow velocity analysis can provide objective criteria for refining the selection of cases for revascularization, and prospective clinical data have confirmed the safety of deferring intervention on lesions with normal physiologic assessment. Translesional and distal coronary flow velocity dynamics during procedures also yield immediate information regarding the physiologic adequacy of intervention. The preliminary results of the DEBATE study indicate that impaired post-PTCA coronary flow reserve (CFR) predicts subsequent clinical events, and data comparing flow velocity indices pre- and post-stenting suggest physiologically inadequate results of PTCA may be improved by additional intervention. Flow velocity assessment may also have utility in profiling the adequacy of infarct artery reperfusion following acute myocardial infarction. Evidence has been accumulated to support an expanding use of Doppler flow velocity analysis as a clinically relevant and cost-effective technique for improving both diagnostic and therapeutic decisions in interventional cardiology.
KeywordsFractional Flow Reserve Coronary Flow Reserve Coronary Flow Velocity Flow Velocity Measurement Hemodynamic Significance
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