Comparison of coronary angiography and intracoronary imaging with fractional flow reserve for coronary artery disease evaluation: An anatomical-functional mismatch.

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License: CC BY-NC-SA 4.0
Serval ID
serval:BIB_1B3F749B309D
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Comparison of coronary angiography and intracoronary imaging with fractional flow reserve for coronary artery disease evaluation: An anatomical-functional mismatch.
Journal
Anatolian journal of cardiology
Author(s)
Adjedj J., Stoyanov N., Muller O.
ISSN
2149-2271 (Electronic)
ISSN-L
2149-2263
Publication state
Published
Issued date
09/2018
Peer-reviewed
Oui
Volume
20
Number
3
Pages
182-189
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Review
Publication Status: ppublish
Abstract
Myocardial ischemia is a leading cause of death worldwide, and it corresponds to the imbalance between blood supply and myocardial demand. Epicardial coronary artery disease (CAD) is detected on the basis of coronary angiogram, whereas invasive detection of myocardial ischemia induced by coronary stenosis is commonly based on fractional flow reserve (FFR). The use of FFR for revascularization decision-making demonstrated clinical benefit and cost-effectiveness compared with that of angiographic indices. Discrepancies between anatomical metrics and physiological assessment of CAD are frequent, which lead to change in revascularization decision from angiography compared to functional evaluation of CAD. Despite several clinical studies and guidelines recommending with high level of evidence demonstrating that FFR should be adopted in stable CAD, revascularization decision-making is still based on coronary angiogram in current practice. Because of the unique coronary anatomy, coronary stenosis characteristics, risk factors profile, and microcirculation quality, the unique evaluation based on epicardial coronary stenosis threshold failed to be a landmark of ischemia compared with FFR. Furthermore, coronary angiogram can detect only epicardial vessels, which represent only 10% of the entire coronary vasculature; therefore, microcirculation is not seen and is poorly assessed in clinical practice. Thus, the role of microcirculation is of importance in myocardial ischemia and might impact these discrepancies between angiography and FFR evaluation of CAD. In this review, we aimed to describe the poor correlation between anatomical evaluation compared with physiological evaluation to detect myocardial ischemia induced by coronary stenosis as well as the clinical implications of this visual-functional mismatch.
Keywords
Coronary Angiography, Coronary Artery Disease/diagnostic imaging, Coronary Artery Disease/epidemiology, Coronary Artery Disease/etiology, Coronary Stenosis/complications, Coronary Stenosis/diagnostic imaging, Fractional Flow Reserve, Myocardial, Humans, Imaging, Three-Dimensional, Microcirculation/physiology, Risk Factors, Tomography, Optical Coherence, Ultrasonography, Interventional
Pubmed
Web of science
Open Access
Yes
Create date
04/09/2018 8:30
Last modification date
20/08/2019 12:52
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