[New methods of functional assessment in the catheterization room. Pressure wire, Doppler flow wire and echocontrastomyography].
Although coronary angiography has been used for many years in the evaluation of coronary artery disease the limitations of this technique are well known. The functional significance of individual coronary artery stenoses may not be easily determined particularly in patients with intermediate stenoses, lesions with irregular and complex morphology and in subjects with multivessel diffuse disease and/or prior myocardial infarction. In selected patients, the role of abnormalities of vasomotion and function at the microcirculatory level cannot be assessed with lone coronary angiography. The functional evaluation of the results of percutaneous coronary interventions usually requires adjunctive non-invasive testing. New techniques for physiological evaluation of coronary artery disease are now available in the catheterization laboratory. The intracoronary pressure wires and Doppler flow wires may provide for an accurate evaluation of the functional significance of the individual stenosis and of the vasodilatory capacity of the coronary bed. Disease of the coronary microcirculation and vasomotion abnormalities may be recognized. Several studies have indicated that these techniques may be helpful in the clinical decision-making process. The strategy of deferring or performing percutaneous coronary interventions may be guided by on-line functional evaluation of the target stenosis and the result of interventions may be evaluated. In addition, new imaging modalities such as myocardial contrast echocardiography with new sonicated agents for intracoronary use may represent a novel approach to the direct evaluation of regional myocardial perfusion and microvascular integrity. The application of these techniques is safe, useful and cost-effective. Unfortunately, physiologic evaluation of the coronary artery disease by means of these techniques still remains confined to few catheterization laboratories.
Verna
E
E
Sezione di Emodinamica, Ospedale di Circolo, Fondazione Macchi, Varese.
Caico
S I
SI
Ghiringhelli
S
S
D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D009213:Myography; D011312:Pressure; D018608:Ultrasonography, Doppler