Diagnostic value of combined evaluation of hyperemic and non-hyperemic intracoronary pressure ratios
Üveges Áron1,2,3 Tar Balázs1,3, Jenei Csaba2,3, Szabó Gábor Tamás2,3, Kőszegi Zsolt1,2,3
1Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház, III. sz. Belgyógyászati Osztály, Nyíregyháza
2Debreceni Egyetem, Kardiológiai és Szívsebészeti Klinika, Debrecen
3Debreceni Egyetem, Laki Kálmán Doktori Iskola, Debrecen
Recently, two large scale outcome trial have proved that non-hyperemic pressure ratio has similar ability for the guidance of revascularization of coronary stenosis than using the hyperemic fractional flow reserve (FFR). However, the relevance of the discordant results between the hyperemic and non-hyperemic pressure ratios has not clarified. In this review we describe the clinical value and the physiological mechanism of the pressure gradients during different flow condition in the coronary artery. We explore the possibilities of the combined measurements for detecting myocardial ischemia caused by either epicardial or microvascular components. We also propose an algorithm for the evaluation of the functional relevance of the coronary stenosis starting by the less invasive image based FFR calculations followed by invasive non-hyperemic and hyperemic pressure ratio measurements in case of the interval between 0.75-0.85 of the image based FFR values.
In our opinion this complex strategy provides comprehensive evaluation of the pathophysiological state of the coronary disease beyond the morphological features of the stenoses and allows us to choose the most appropriate therapy for the patient.