Chapter 7
Physiologic Assessment and Guidance in the Cardiac Catheterization Laboratory
Allen Jeremias,
Sukhjinder Nijjer,
Justin Davies,
Carlo DiMario,
Allen Jeremias
Search for more papers by this authorSukhjinder Nijjer
Search for more papers by this authorJustin Davies
Search for more papers by this authorCarlo DiMario
Search for more papers by this authorAllen Jeremias,
Sukhjinder Nijjer,
Justin Davies,
Carlo DiMario,
Allen Jeremias
Search for more papers by this authorSukhjinder Nijjer
Search for more papers by this authorJustin Davies
Search for more papers by this authorCarlo DiMario
Search for more papers by this authorBook Editor(s):George D. Dangas MD, MACC, MSCAI, FAHA, FESC,
Carlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC,
Holger Thiele MD,
Peter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP,
Tayo Addo MD, Bimmer Claessen MD, Christian Hengstenberg MD, Nicholas Kipshidze MD,
George D. Dangas MD, MACC, MSCAI, FAHA, FESC
Professor of Medicine (Cardiology) & Surgery (Vascular) Professor of Cardiology Adjunct Professor of Internal Medicine
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
National Kapodistrian University of Athens, Greece
Medical University of Vienna, Austria
Search for more papers by this authorCarlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC
Professor of Cardiology Director of the Structural Interventional Cardiology Division Honorary Consultant
University of Florence
University Hospital Careggi, Florence, Italy
Cardiologist Royal Brompton Hospital, London, UK
Search for more papers by this authorHolger Thiele MD
Professor of Cardiology at University of Leipzig
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Search for more papers by this authorPeter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP
Professor of Cardiology Interventional Cardiologist
University of Melbourne, Melbourne, Victoria, Australia
St Vincent's & Northern Hospitals Victoria, Australia
Search for more papers by this authorFirst published: 06 May 2022
Summary
The purpose of angiography and revascularization is to improve blood flow and thereby reduce myocardial ischemia. Pressure wire assessment can add utility in patients who have recurrent chest pain but angiographically unobstructed coronary arteries. This chapter discusses the matters in turn with a focus upon the practical application of coronary physiology in day-to-day practice. It focuses on pressure-based indices Fractional Flow Reserve (FFR) and non-hyperemic pressure ratios, which are measured under hyperemic and resting conditions, respectively. Non-specific agents such as adenosine and papaverine are commonly used to induce maximal hyperemia for assessment of indices such as Coronary Flow Reserve, FFR and index of microcirculatory resistance. FFR is recognized as the reference standard for coronary physiology in the catheter laboratory. The instantaneous wave-free ratio is a resting index of stenosis severity which quantifies the impact a stenosis upon the coronary circulation. Physiological indices can provide an assessment of the success of coronary intervention.
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