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Review
. 2023 Aug 29;3(5):689-706.
doi: 10.1016/j.jacasi.2023.07.003. eCollection 2023 Oct.

Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 1

Bon-Kwon Koo  1 , Joo Myung Lee  2 , Doyeon Hwang  1 , Sungjoon Park  1 , Yasutsugu Shiono  3 , Taishi Yonetsu  4 , Seung Hun Lee  5 , Yoshiaki Kawase  6 , Jung-Min Ahn  7 , Hitoshi Matsuo  6 , Eun-Seok Shin  8 , Xinyang Hu  9 , Daixin Ding  10   11 , Simone Fezzi  11   12 , Shengxian Tu  10 , Adrian F Low  13 , Takashi Kubo  14 , Chang-Wook Nam  15 , Andy S C Yong  16 , Scott A Harding  17 , Bo Xu  18 , Seung-Ho Hur  15 , Gim Hooi Choo  19 , Huay Cheem Tan  13 , Ajit Mullasari  20 , I-Chang Hsieh  21 , Tsunekazu Kakuta  22 , Takashi Akasaka  3 , Jian'an Wang  9 , Seung-Jea Tahk  23 , William F Fearon  24 , Javier Escaned  25 , Seung-Jung Park  7
Affiliations
Review

Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 1

Bon-Kwon Koo et al. JACC Asia. .

Abstract

Coronary physiologic assessment is performed to measure coronary pressure, flow, and resistance or their surrogates to enable the selection of appropriate management strategy and its optimization for patients with coronary artery disease. The value of physiologic assessment is supported by a large body of evidence that has led to major recommendations in clinical practice guidelines. This expert consensus document aims to convey practical and balanced recommendations and future perspectives for coronary physiologic assessment for physicians and patients in the Asia-Pacific region based on updated information in the field that including both wire- and image-based physiologic assessment. This is Part 1 of the whole consensus document, which describes the general concept of coronary physiology, as well as practical information on the clinical application of physiologic indices and novel image-based physiologic assessment.

Keywords: Asia-Pacific; coronary artery disease; coronary physiologic assessment.

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Conflict of interest statement

This work is supported by the grant from the Patient-Centered Clinical Research Coordinating Center (grant number: HC19C0305). Dr Koo has received institutional research grants from Abbott Vascular, Boston Scientific, Philips, and HeartFlow. Dr Joo Myung Lee has received institutional research grants from Abbott Vascular, Boston Scientific, Philips Volcano, Terumo Corporation, Zoll Medical, and Donga-ST. Dr Seung Hun Lee has received an institutional research grant from Abbott Vascular. Dr Tu is a co-founder of Pulse Medical and has received institutional research grants from Pulse Medical. Dr Nam has received an institutional research grant from Abbott Vascular. Dr Yong has received honoraria from Abbott Vascular; and has received institutional research grants and support from Abbott Vascular and Philips. Dr Harding has received proctoring fees/speaker honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Terumo Medical. Dr Hu has received an institutional research grant from Boston Scientific. Dr Wang has received an institutional research grant from Boston Scientific. Dr Fearon has received institutional research support from Abbott, Boston Scientific, and Medtronic; has received consulting fees from CathWorks and Siemens; and has stock options with HeartFlow. Dr Escaned has received personal fees as speaker or advisory board member from Abbott, Boston Scientific, Medis, RainMed, and Philips; he also reports joint ownership of angio-IMR patent. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1
Figure 1
Procedural Steps of Intracoronary Pressure Measurements Intracoronary pressure measurement is performed through the process of calibration, equalization, wire positioning, nonhyperemic pressure ratio/fractional flow reserve measurements, pullback procedure, and drift check.
Figure 2
Figure 2
Practical Points in Coronary Flow Measurements Coronary flow can be assessed using a guidewire equipped with Doppler sensor (A) or a pressure-temperature sensor (B).
Figure 3
Figure 3
Practical Approach for PCI Optimization Using Coronary Physiology After checking the necessity of revascularization with fractional flow reserve (FFR) or nonhyperemic pressure ratios (NHPRs), the type of lesion (focal vs diffuse) should also be considered as an indication of effective percutaneous coronary intervention (PCI) using pullback data of NHPRs and FFR. Green background indicates the current guideline recommendation. Yellow background and dotted line indicate the practically useful methods with supporting clinical data. PPG = pullback pressure gradient.
Figure 4
Figure 4
Concept of 2-Dimensional Characterization of Coronary Atherosclerotic Disease Patterns The 2-dimensional characterization of coronary atherosclerotic disease consists of physiologic distribution (predominant focal vs diffuse) and physiologic local severity (major vs no major gradient). Physiologic distribution can be objectively assessed by PPG index. Physiologic local severity can be objectively assessed by instantaneous gradient per unit length. Modified with permission from Shin et al. CAD = coronary artery disease; other abbreviations as in Figure 3.
Figure 5
Figure 5
QFR-Guided Revascularization Strategy Decision Making, Virtual Stenting, and Post-PCI Evaluation (A) According to pre-PCI QFR, PCI was indicated for left anterior descending (LAD) and left circumflex (LCx) arteries. (B) For LAD, virtual stenting strategy provides optimal residual quantitative flow ratio (QFR) of 0.96. For LCx, virtual stenting strategy provides optimal residual QFR of 0.97. (C) Immediately after PCI, QFR was 0.93 for LAD and 0.94 for LCx. RCA = right coronary artery; other abbreviations as in Figure 3.
See this image and copyright information in PMC

Comment in

References

    1. Lawton J.S., Tamis-Holland J.E., Bangalore S., et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2022;79(2):197–215. - PubMed
    1. Hwang D., Lee J.M., Yang S., et al. Role of post-stent physiological assessment in a risk prediction model after coronary stent implantation. J Am Coll Cardiol Intv. 2020;13:1639–1650. - PubMed
    1. Hong D., Lee S.H., Shin D., et al. Prognosis and medical cost of measuring fractional flow reserve in percutaneous coronary intervention. JACC Asia. 2022;2:590–603. - PMC - PubMed
    1. Maron D.J., Hochman J.S., Reynolds H.R., et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med. 2020;382:1395–1407. - PMC - PubMed
    1. Gruntzig A.R., Senning A., Siegenthaler W.E. Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med. 1979;301:61–68. - PubMed

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