title: Advances in coronary physiology.
abstract: Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes. We also review the instantaneous wave-free ratio (iFR), a new pressure-only index, measured at rest, that is under active evaluation in several international randomized controlled trials. We review the accumulated evidence and discuss the important physiological concepts between pressure and flow that underlie the approach to using resting indices. Finally we investigate future developments, including physiological mapping with iFR-Pullback and the potential to predict the hemodynamic effect of stenting.
authors: International Centre of Circulatory Health, Imperial College London.
authors: Sukhjinder S
authors: SS
authors: Nijjer
authors: Sayan
authors: S
authors: Sen
authors: Ricardo
authors: R
authors: Petraco
authors: Justin Er
authors: JE
authors: Davies
mesh_terms: D000241:Adenosine / Q000494:pharmacology; D006328:Cardiac Catheterization / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000503:physiopathology; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D009204:Myocardial Revascularization / Q000379:methods; D015607:Stents; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine