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Coronary Physiology: Basic Concepts and Clinical Applications
Intravascular Physiology
PREFACE Coronary Physiology: Basic Concepts and Clinical Applications
Allen Jeremias, MD, MSc Editor
The routine clinical application of coronary physiology has become available with the introduction of Fractional Flow Reserve (FFR) over 20 years ago. The premise of FFR is to assess the hemodynamic significance of a coronary stenosis by comparing distal coronary pressure to the aortic pressure as a surrogate for coronary flow. Since the original description by Pijls and colleagues in 1993, more than 1500 articles have been published containing the keyword “FFR”, and coronary pressure measurements have become mainstream. Nevertheless, despite convincing clinical trial evidence demonstrating the benefits of FFR, clinical adoption remains low with only about 10% of coronary angiograms undergoing an FFR evaluation. This issue of Interventional Cardiology Clinics is dedicated to coronary physiology, providing an excellent overview of the basic concepts, historical advances in the field, clinical trial evidence, practical applications, and future developments. The authors are international experts in coronary physiology and have significantly contributed to the scientific progress in this space. In addition to an in-depth discussion on FFR (including its limitations and pitfalls), there is a focus on Coronary Flow Reserve in
the context of assessing microvascular disease, the association of wall shear stress and plaque progression, the potential advantages of using resting pressure indices such as instant wavefree ratio, and the noninvasive evaluation of FFR derived from coronary computed tomography angiography. It is my hope that this issue will contribute to the much needed expansion of physiology measurements in routine clinical practice in an era of increasing scrutiny of coronary revascularization procedures. I would like to extend my gratitude to all authors who contributed to this issue of Interventional Cardiology Clinics. I hope that this issue provides a relevant and up-to-date overview of coronary physiology and will help implement some of these concepts into daily clinical practice.
Intervent Cardiol Clin 4 (2015) ix http://dx.doi.org/10.1016/j.iccl.2015.08.001 2211-7458/15/$ – see front matter ª 2015 Published by Elsevier Inc.
Allen Jeremias, MD, MSc Department of Medicine Division of Cardiovascular Medicine Health Sciences Center, T16-080 Stony Brook, NY 11794-8160, USA E-mail address: [email protected]
PREFACE Coronary Physiology: Basic Concepts and Clinical Applications
Allen Jeremias, MD, MSc Editor
The routine clinical application of coronary physiology has become available with the introduction of Fractional Flow Reserve (FFR) over 20 years ago. The premise of FFR is to assess the hemodynamic significance of a coronary stenosis by comparing distal coronary pressure to the aortic pressure as a surrogate for coronary flow. Since the original description by Pijls and colleagues in 1993, more than 1500 articles have been published containing the keyword “FFR”, and coronary pressure measurements have become mainstream. Nevertheless, despite convincing clinical trial evidence demonstrating the benefits of FFR, clinical adoption remains low with only about 10% of coronary angiograms undergoing an FFR evaluation. This issue of Interventional Cardiology Clinics is dedicated to coronary physiology, providing an excellent overview of the basic concepts, historical advances in the field, clinical trial evidence, practical applications, and future developments. The authors are international experts in coronary physiology and have significantly contributed to the scientific progress in this space. In addition to an in-depth discussion on FFR (including its limitations and pitfalls), there is a focus on Coronary Flow Reserve in
the context of assessing microvascular disease, the association of wall shear stress and plaque progression, the potential advantages of using resting pressure indices such as instant wavefree ratio, and the noninvasive evaluation of FFR derived from coronary computed tomography angiography. It is my hope that this issue will contribute to the much needed expansion of physiology measurements in routine clinical practice in an era of increasing scrutiny of coronary revascularization procedures. I would like to extend my gratitude to all authors who contributed to this issue of Interventional Cardiology Clinics. I hope that this issue provides a relevant and up-to-date overview of coronary physiology and will help implement some of these concepts into daily clinical practice.
Intervent Cardiol Clin 4 (2015) ix http://dx.doi.org/10.1016/j.iccl.2015.08.001 2211-7458/15/$ – see front matter ª 2015 Published by Elsevier Inc.
Allen Jeremias, MD, MSc Department of Medicine Division of Cardiovascular Medicine Health Sciences Center, T16-080 Stony Brook, NY 11794-8160, USA E-mail address: [email protected]