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Coronary artery disease evaluation by coronary angiography and intracoronary imaging compared to Fractional Flow Reserve: anatomical-functional mismatch. [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-42949 | DOI: 10.14744/AnatolJCardiol.2018.42949  

Coronary artery disease evaluation by coronary angiography and intracoronary imaging compared to Fractional Flow Reserve: anatomical-functional mismatch.

Julien Adjedj, Nikolay Stoyanov, Olivier Muller
CHUV, Cardiology Department, Lausanne University Hospital, Switzerland.

Myocardial ischemia is a leading cause of death worldwide it corresponds to the imbalance between blood supply and myocardial demand. Epicardial coronary artery disease (CAD) detection is based on coronary angiogram, while invasive detection of myocardial ischemia induced by coronary stenosis is commonly based on Fractional Flow Reserve (FFR). The FFR use for revascularisation decision demonstrated clinical and cost-effectiveness benefit compared to angiographic indices. Discrepancies between anatomical metrics and physiological assessment of CAD is frequent which lead to change revascularisation decision from angiography compared to functional evaluation of CAD. Despite several clinical studies result and guidelines recommendations with high level of evidence to adopt FFR in stable CAD, revascularisation decision based on coronary angiogram remains current practice. Because of unique coronary anatomy, coronary stenosis characteristics, risk factors profile and microcirculation quality, epicardial coronary stenosis threshold failed to be a landmark of ischemia compared to FFR. Furthermore, coronary angiogram can detect only epicardial vessels which represents only 10% of the entire coronary vasculature, microcirculation is therefore not seen and poorly assess in clinical practice. Therefore, 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 to physiological evaluation to detect myocardial ischemia induced by coronary stenosis and clinical implications of this visual-functional mismatch.

Keywords: Coronary Artery Disease, coronary angiography, Fractional Flow Reserve, Cardiovascular Risk Factors.




Corresponding Author: Julien Adjedj, Switzerland


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