Physiological assessment of coronary stenosis: a view from the coronary microcirculation
The complexity of ischemic heart disease (IHD) comprehends disease in the succeeding perfusion domains of the vascular tree. Fractional flow reserve and coronary flow reserve are validated diagnostic modalities to identify myocardial ischemia, but solitarily do not suffice to objectify the respectiv...
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| Veröffentlicht in: | Interventional cardiology 2015-08, Vol.7 (4), p.403-416 |
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| container_title | Interventional cardiology |
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| creator | Wijntjens, Gilbert WM van Lavieren, Martijn A van de Hoef, Tim P Piek, Jan J |
| description | The complexity of ischemic heart disease (IHD) comprehends disease in the succeeding perfusion domains of the vascular tree. Fractional flow reserve and coronary flow reserve are validated diagnostic modalities to identify myocardial ischemia, but solitarily do not suffice to objectify the respective contribution of obstructive and nonobstructive disease to IHD. Combined pressure and flow measurements deliver a comprehensive intracoronary assessment of IHD, although fractional flow reserve and coronary flow reserve disagree in 40% of the cases. Discrepancy between the indices does not reflect methodological failure, but explores divergent extremes of epicardial and microvascular disease, which holds vital prognostic value. We advocate critical revision of the current diagnostic and therapeutic approaches toward IHD. In this review, we deliver a perspective on the future developments in the diagnosis and treatment of IHD. |
| doi_str_mv | 10.2217/ica.15.24 |
| format | Article |
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Fractional flow reserve and coronary flow reserve are validated diagnostic modalities to identify myocardial ischemia, but solitarily do not suffice to objectify the respective contribution of obstructive and nonobstructive disease to IHD. Combined pressure and flow measurements deliver a comprehensive intracoronary assessment of IHD, although fractional flow reserve and coronary flow reserve disagree in 40% of the cases. Discrepancy between the indices does not reflect methodological failure, but explores divergent extremes of epicardial and microvascular disease, which holds vital prognostic value. We advocate critical revision of the current diagnostic and therapeutic approaches toward IHD. In this review, we deliver a perspective on the future developments in the diagnosis and treatment of IHD.</description><identifier>ISSN: 1755-5302</identifier><identifier>EISSN: 1755-5310</identifier><identifier>DOI: 10.2217/ica.15.24</identifier><language>eng</language><publisher>Future Medicine Ltd</publisher><subject>Care and treatment ; coronary artery disease ; coronary flow reserve ; coronary microvascular dysfunction ; coronary microvascular resistance ; Coronary stenosis ; Diagnosis ; fractional flow reserve ; Health aspects ; ischemic heart disease ; Microcirculation</subject><ispartof>Interventional cardiology, 2015-08, Vol.7 (4), p.403-416</ispartof><rights>Future Medicine Ltd</rights><rights>COPYRIGHT 2015 Future Medicine Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c257t-5acccad22f256446187b3697b4f26a3894d0ec1f8b7850f91b16b7fd3a8a8e9a3</citedby><cites>FETCH-LOGICAL-c257t-5acccad22f256446187b3697b4f26a3894d0ec1f8b7850f91b16b7fd3a8a8e9a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Wijntjens, Gilbert WM</creatorcontrib><creatorcontrib>van Lavieren, Martijn A</creatorcontrib><creatorcontrib>van de Hoef, Tim P</creatorcontrib><creatorcontrib>Piek, Jan J</creatorcontrib><title>Physiological assessment of coronary stenosis: a view from the coronary microcirculation</title><title>Interventional cardiology</title><description>The complexity of ischemic heart disease (IHD) comprehends disease in the succeeding perfusion domains of the vascular tree. Fractional flow reserve and coronary flow reserve are validated diagnostic modalities to identify myocardial ischemia, but solitarily do not suffice to objectify the respective contribution of obstructive and nonobstructive disease to IHD. Combined pressure and flow measurements deliver a comprehensive intracoronary assessment of IHD, although fractional flow reserve and coronary flow reserve disagree in 40% of the cases. Discrepancy between the indices does not reflect methodological failure, but explores divergent extremes of epicardial and microvascular disease, which holds vital prognostic value. We advocate critical revision of the current diagnostic and therapeutic approaches toward IHD. In this review, we deliver a perspective on the future developments in the diagnosis and treatment of IHD.</description><subject>Care and treatment</subject><subject>coronary artery disease</subject><subject>coronary flow reserve</subject><subject>coronary microvascular dysfunction</subject><subject>coronary microvascular resistance</subject><subject>Coronary stenosis</subject><subject>Diagnosis</subject><subject>fractional flow reserve</subject><subject>Health aspects</subject><subject>ischemic heart disease</subject><subject>Microcirculation</subject><issn>1755-5302</issn><issn>1755-5310</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNptkEtLxDAQx4MouKx78BsEPHlozaNpWm_L4gsW9KDgLaTpZDfSNpJ0lf32RiqKsDOHefD7DzOD0DklOWNUXjmjcypyVhyhGZVCZIJTcvybE3aKFjG-kWSc1YTQGXp92u6j853fJHGHdYwQYw_DiL3Fxgc_6LDHcYTBRxevscYfDj6xDb7H4xb-kN6Z4I0LZtfp0fnhDJ1Y3UVY_MQ5erm9eV7dZ-vHu4fVcp0ZJuSYCW2M0S1jlomyKEpayYaXtWwKy0rNq7poCRhqq0ZWgtiaNrRspG25rnQFteZzdDHN3egOlBusH4M2vYtGLQtOBZOS8UTlB6jkLaTF_QDWpf4_weUkSFfFGMCq9-D6dKiiRH0_W6V_KSoUKxIrJtbuxl2AaBwMBtRU9dA64wY4oPsCRcGE9Q</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Wijntjens, Gilbert WM</creator><creator>van Lavieren, Martijn A</creator><creator>van de Hoef, Tim P</creator><creator>Piek, Jan J</creator><general>Future Medicine Ltd</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20150801</creationdate><title>Physiological assessment of coronary stenosis: a view from the coronary microcirculation</title><author>Wijntjens, Gilbert WM ; van Lavieren, Martijn A ; van de Hoef, Tim P ; Piek, Jan J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c257t-5acccad22f256446187b3697b4f26a3894d0ec1f8b7850f91b16b7fd3a8a8e9a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Care and treatment</topic><topic>coronary artery disease</topic><topic>coronary flow reserve</topic><topic>coronary microvascular dysfunction</topic><topic>coronary microvascular resistance</topic><topic>Coronary stenosis</topic><topic>Diagnosis</topic><topic>fractional flow reserve</topic><topic>Health aspects</topic><topic>ischemic heart disease</topic><topic>Microcirculation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wijntjens, Gilbert WM</creatorcontrib><creatorcontrib>van Lavieren, Martijn A</creatorcontrib><creatorcontrib>van de Hoef, Tim P</creatorcontrib><creatorcontrib>Piek, Jan J</creatorcontrib><collection>CrossRef</collection><jtitle>Interventional cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wijntjens, Gilbert WM</au><au>van Lavieren, Martijn A</au><au>van de Hoef, Tim P</au><au>Piek, Jan J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Physiological assessment of coronary stenosis: a view from the coronary microcirculation</atitle><jtitle>Interventional cardiology</jtitle><date>2015-08-01</date><risdate>2015</risdate><volume>7</volume><issue>4</issue><spage>403</spage><epage>416</epage><pages>403-416</pages><issn>1755-5302</issn><eissn>1755-5310</eissn><abstract>The complexity of ischemic heart disease (IHD) comprehends disease in the succeeding perfusion domains of the vascular tree. 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| ispartof | Interventional cardiology, 2015-08, Vol.7 (4), p.403-416 |
| issn | 1755-5302 1755-5310 |
| language | eng |
| recordid | cdi_gale_infotracmisc_A431527723 |
| source | EZB-FREE-00999 freely available EZB journals |
| subjects | Care and treatment coronary artery disease coronary flow reserve coronary microvascular dysfunction coronary microvascular resistance Coronary stenosis Diagnosis fractional flow reserve Health aspects ischemic heart disease Microcirculation |
| title | Physiological assessment of coronary stenosis: a view from the coronary microcirculation |
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