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Invasive and non-invasive assessment of ischaemia in chronic coronary syndromes: translating pathophysiology to clinical practice

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Invasive and non-invasive assessment of ischaemia in chronic coronary syndromes : translating pathophysiology to clinical practice. / Demir, Ozan M; Rahman, Haseeb; van de Hoef, Tim P et al.

In: European Heart Journal, Vol. 43, No. 2, 07.01.2022, p. 105-117.

Research output: Contribution to journalArticlepeer-review

Harvard

Demir, OM, Rahman, H, van de Hoef, TP, Escaned, J, Piek, JJ, Plein, S & Perera, D 2022, 'Invasive and non-invasive assessment of ischaemia in chronic coronary syndromes: translating pathophysiology to clinical practice', European Heart Journal, vol. 43, no. 2, pp. 105-117. https://doi.org/10.1093/eurheartj/ehab548

APA

Demir, O. M., Rahman, H., van de Hoef, T. P., Escaned, J., Piek, J. J., Plein, S., & Perera, D. (2022). Invasive and non-invasive assessment of ischaemia in chronic coronary syndromes: translating pathophysiology to clinical practice. European Heart Journal, 43(2), 105-117. https://doi.org/10.1093/eurheartj/ehab548

Vancouver

Demir OM, Rahman H, van de Hoef TP, Escaned J, Piek JJ, Plein S et al. Invasive and non-invasive assessment of ischaemia in chronic coronary syndromes: translating pathophysiology to clinical practice. European Heart Journal. 2022 Jan 7;43(2):105-117. https://doi.org/10.1093/eurheartj/ehab548

Author

Demir, Ozan M ; Rahman, Haseeb ; van de Hoef, Tim P et al. / Invasive and non-invasive assessment of ischaemia in chronic coronary syndromes : translating pathophysiology to clinical practice. In: European Heart Journal. 2022 ; Vol. 43, No. 2. pp. 105-117.

Bibtex Download

@article{7fe74c30975c4d6eb4b7a71cea1cd0e3,
title = "Invasive and non-invasive assessment of ischaemia in chronic coronary syndromes: translating pathophysiology to clinical practice",
abstract = "Intracoronary physiology testing has emerged as a valuable diagnostic approach in the management of patients with chronic coronary syndrome, circumventing limitations like inferring coronary function from anatomical assessment and low spatial resolution associated with angiography or non-invasive tests. The value of hyperaemic translesional pressure ratios to estimate the functional relevance of coronary stenoses is supported by a wealth of prognostic data. The continuing drive to further simplify this approach led to the development of non-hyperaemic pressure-based indices. Recent attention has focussed on estimating physiology without even measuring coronary pressure. However, the reduction in procedural time and ease of accessibility afforded by these simplifications needs to be counterbalanced against the increasing burden of physiological assumptions, which may impact on the ability to reliably identify an ischaemic substrate, the ultimate goal during catheter laboratory assessment. In that regard, measurement of both coronary pressure and flow enables comprehensive physiological evaluation of both epicardial and microcirculatory components of the vasculature, although widespread adoption has been hampered by perceived technical complexity and, in general, an underappreciation of the role of the microvasculature. In parallel, entirely non-invasive tools have matured, with the utilization of various techniques including computational fluid dynamic and quantitative perfusion analysis. This review article appraises the strengths and limitations for each test in investigating myocardial ischaemia and discusses a comprehensive algorithm that could be used to obtain a diagnosis in all patients with angina scheduled for coronary angiography, including those who are not found to have obstructive epicardial coronary disease.",
author = "Demir, {Ozan M} and Haseeb Rahman and {van de Hoef}, {Tim P} and Javier Escaned and Piek, {Jan J} and Sven Plein and Divaka Perera",
note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.",
year = "2022",
month = jan,
day = "7",
doi = "10.1093/eurheartj/ehab548",
language = "English",
volume = "43",
pages = "105--117",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "2",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Invasive and non-invasive assessment of ischaemia in chronic coronary syndromes

T2 - translating pathophysiology to clinical practice

AU - Demir, Ozan M

AU - Rahman, Haseeb

AU - van de Hoef, Tim P

AU - Escaned, Javier

AU - Piek, Jan J

AU - Plein, Sven

AU - Perera, Divaka

N1 - © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2022/1/7

Y1 - 2022/1/7

N2 - Intracoronary physiology testing has emerged as a valuable diagnostic approach in the management of patients with chronic coronary syndrome, circumventing limitations like inferring coronary function from anatomical assessment and low spatial resolution associated with angiography or non-invasive tests. The value of hyperaemic translesional pressure ratios to estimate the functional relevance of coronary stenoses is supported by a wealth of prognostic data. The continuing drive to further simplify this approach led to the development of non-hyperaemic pressure-based indices. Recent attention has focussed on estimating physiology without even measuring coronary pressure. However, the reduction in procedural time and ease of accessibility afforded by these simplifications needs to be counterbalanced against the increasing burden of physiological assumptions, which may impact on the ability to reliably identify an ischaemic substrate, the ultimate goal during catheter laboratory assessment. In that regard, measurement of both coronary pressure and flow enables comprehensive physiological evaluation of both epicardial and microcirculatory components of the vasculature, although widespread adoption has been hampered by perceived technical complexity and, in general, an underappreciation of the role of the microvasculature. In parallel, entirely non-invasive tools have matured, with the utilization of various techniques including computational fluid dynamic and quantitative perfusion analysis. This review article appraises the strengths and limitations for each test in investigating myocardial ischaemia and discusses a comprehensive algorithm that could be used to obtain a diagnosis in all patients with angina scheduled for coronary angiography, including those who are not found to have obstructive epicardial coronary disease.

AB - Intracoronary physiology testing has emerged as a valuable diagnostic approach in the management of patients with chronic coronary syndrome, circumventing limitations like inferring coronary function from anatomical assessment and low spatial resolution associated with angiography or non-invasive tests. The value of hyperaemic translesional pressure ratios to estimate the functional relevance of coronary stenoses is supported by a wealth of prognostic data. The continuing drive to further simplify this approach led to the development of non-hyperaemic pressure-based indices. Recent attention has focussed on estimating physiology without even measuring coronary pressure. However, the reduction in procedural time and ease of accessibility afforded by these simplifications needs to be counterbalanced against the increasing burden of physiological assumptions, which may impact on the ability to reliably identify an ischaemic substrate, the ultimate goal during catheter laboratory assessment. In that regard, measurement of both coronary pressure and flow enables comprehensive physiological evaluation of both epicardial and microcirculatory components of the vasculature, although widespread adoption has been hampered by perceived technical complexity and, in general, an underappreciation of the role of the microvasculature. In parallel, entirely non-invasive tools have matured, with the utilization of various techniques including computational fluid dynamic and quantitative perfusion analysis. This review article appraises the strengths and limitations for each test in investigating myocardial ischaemia and discusses a comprehensive algorithm that could be used to obtain a diagnosis in all patients with angina scheduled for coronary angiography, including those who are not found to have obstructive epicardial coronary disease.

UR - http://www.scopus.com/inward/record.url?scp=85123646411&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehab548

DO - 10.1093/eurheartj/ehab548

M3 - Article

C2 - 34516621

VL - 43

SP - 105

EP - 117

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 2

ER -

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