Implementation of Coronary Physiology in complex clinical and angiographic scenarios

Cronary angiography was, for many years, the only available tool to diagnose and assess the consequences of coronary atherosclerosis, becoming the standard reference in the study of ischemic heart disease allowing to routinely describe the severity of coronary stenosis or the severity of the disease...

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Detalhes bibliográficos
Autor: Cerrato, Enrico
Tipo de documento: tese
Data de publicação:2021
País:España
Recursos:Universidad Complutense de Madrid (UCM)
Repositório:Docta Complutense
Idioma:inglês
OAI Identifier:oai:docta.ucm.es:20.500.14352/5503
Acesso em linha:https://hdl.handle.net/20.500.14352/5503
Access Level:Acceso aberto
Palavra-chave:616.13/.14-073.75(043.2)
Coronary Physiology
Cronary angiography
Fisiología Coronaria
Angiografía coronaria
Sistema cardiovascular
2411.03 Fisiología Cardiovascular
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spelling Implementation of Coronary Physiology in complex clinical and angiographic scenariosAplicaciones de la Fisiología Coronaria en escenarios clínicos y angiográficos complejosCerrato, Enrico616.13/.14-073.75(043.2)Coronary PhysiologyCronary angiographyFisiología CoronariaAngiografía coronariaSistema cardiovascular2411.03 Fisiología CardiovascularCronary angiography was, for many years, the only available tool to diagnose and assess the consequences of coronary atherosclerosis, becoming the standard reference in the study of ischemic heart disease allowing to routinely describe the severity of coronary stenosis or the severity of the disease based on the number of vessels affected. Subsequently, the introduction of invasive methods to assess coronary physiology allowed to obtain a precise assessment regarding the physiological impact of epicardial coronary stenoses, while demonstrating the poor diagnostic performance of angiography to assess the functional impact these stenoses. Among the coronary physiology techniques, the fractional flow reserve (FFR) and the instantaneous wave-free ratio (iFR) are the most used and are currently recommended in clinical practice to decide whether coronary revascularization is indicated. Both techniques received the highest grade of recommendation in the latest European guidelines for myocardial revascularization in the context of intermediate or doubtful stenosis in patients with stable ischemic heart disease (SIHD). However, despite a growing body of evidence supporting the value of physiology in detecting ischemia, the large-scale adoption of this technique is still limited. It has been pointed out that one of the causes underlying the underuse of FFR is that it requires the induction of pharmacological stress through the use of vasodilator drugs such as adenosine, which potentially causes side effects and an additional cost, especially in a case of need of multiple interrogation in the same coronary tree. Besides, this is certainly due to the fact that the FFR validation was carried out mainly in specific clinical and anatomical subgroups, such as stenoses of intermediate severity and SIHD. The safety of revascularization deferral on the ground of FFR or other physiological indices is also limited in other common clinical settings, such as acute coronary syndromes (ACS), left main coronary artery (LMCA) disease or diabetic patients. Lastly, it should be noted that intracoronary pressure indices share an important limitation with coronary angiography: they do not provide information on the state of the coronary microcirculation. This obstacle not only prevents the diagnosis of non-obstructive causes of myocardial ischemia, but also hinders the advancement of knowledge of specific pharmacological treatments that can provide clinical benefit through the modification of this important domain of the coronary circulation...Universidad Complutense de MadridEscaned Barbosa, JavierMacaya Miguel, CarlosUniversidad Complutense de Madrid20212021-07-1620212021-07-16doctoral thesishttp://purl.org/coar/resource_type/c_db06info:eu-repo/semantics/doctoralThesisapplication/pdfhttps://hdl.handle.net/20.500.14352/5503reponame:Docta Complutenseinstname:Universidad Complutense de Madrid (UCM)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:docta.ucm.es:20.500.14352/55032026-06-02T12:44:21Z
dc.title.none.fl_str_mv Implementation of Coronary Physiology in complex clinical and angiographic scenarios
Aplicaciones de la Fisiología Coronaria en escenarios clínicos y angiográficos complejos
title Implementation of Coronary Physiology in complex clinical and angiographic scenarios
spellingShingle Implementation of Coronary Physiology in complex clinical and angiographic scenarios
Cerrato, Enrico
616.13/.14-073.75(043.2)
Coronary Physiology
Cronary angiography
Fisiología Coronaria
Angiografía coronaria
Sistema cardiovascular
2411.03 Fisiología Cardiovascular
title_short Implementation of Coronary Physiology in complex clinical and angiographic scenarios
title_full Implementation of Coronary Physiology in complex clinical and angiographic scenarios
title_fullStr Implementation of Coronary Physiology in complex clinical and angiographic scenarios
title_full_unstemmed Implementation of Coronary Physiology in complex clinical and angiographic scenarios
title_sort Implementation of Coronary Physiology in complex clinical and angiographic scenarios
dc.creator.none.fl_str_mv Cerrato, Enrico
author Cerrato, Enrico
author_facet Cerrato, Enrico
author_role author
dc.contributor.none.fl_str_mv Escaned Barbosa, Javier
Macaya Miguel, Carlos
Universidad Complutense de Madrid
dc.subject.none.fl_str_mv 616.13/.14-073.75(043.2)
Coronary Physiology
Cronary angiography
Fisiología Coronaria
Angiografía coronaria
Sistema cardiovascular
2411.03 Fisiología Cardiovascular
topic 616.13/.14-073.75(043.2)
Coronary Physiology
Cronary angiography
Fisiología Coronaria
Angiografía coronaria
Sistema cardiovascular
2411.03 Fisiología Cardiovascular
description Cronary angiography was, for many years, the only available tool to diagnose and assess the consequences of coronary atherosclerosis, becoming the standard reference in the study of ischemic heart disease allowing to routinely describe the severity of coronary stenosis or the severity of the disease based on the number of vessels affected. Subsequently, the introduction of invasive methods to assess coronary physiology allowed to obtain a precise assessment regarding the physiological impact of epicardial coronary stenoses, while demonstrating the poor diagnostic performance of angiography to assess the functional impact these stenoses. Among the coronary physiology techniques, the fractional flow reserve (FFR) and the instantaneous wave-free ratio (iFR) are the most used and are currently recommended in clinical practice to decide whether coronary revascularization is indicated. Both techniques received the highest grade of recommendation in the latest European guidelines for myocardial revascularization in the context of intermediate or doubtful stenosis in patients with stable ischemic heart disease (SIHD). However, despite a growing body of evidence supporting the value of physiology in detecting ischemia, the large-scale adoption of this technique is still limited. It has been pointed out that one of the causes underlying the underuse of FFR is that it requires the induction of pharmacological stress through the use of vasodilator drugs such as adenosine, which potentially causes side effects and an additional cost, especially in a case of need of multiple interrogation in the same coronary tree. Besides, this is certainly due to the fact that the FFR validation was carried out mainly in specific clinical and anatomical subgroups, such as stenoses of intermediate severity and SIHD. The safety of revascularization deferral on the ground of FFR or other physiological indices is also limited in other common clinical settings, such as acute coronary syndromes (ACS), left main coronary artery (LMCA) disease or diabetic patients. Lastly, it should be noted that intracoronary pressure indices share an important limitation with coronary angiography: they do not provide information on the state of the coronary microcirculation. This obstacle not only prevents the diagnosis of non-obstructive causes of myocardial ischemia, but also hinders the advancement of knowledge of specific pharmacological treatments that can provide clinical benefit through the modification of this important domain of the coronary circulation...
publishDate 2021
dc.date.none.fl_str_mv 2021
2021-07-16
2021
2021-07-16
dc.type.none.fl_str_mv doctoral thesis
http://purl.org/coar/resource_type/c_db06
dc.type.openaire.fl_str_mv info:eu-repo/semantics/doctoralThesis
format doctoralThesis
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.14352/5503
url https://hdl.handle.net/20.500.14352/5503
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidad Complutense de Madrid
publisher.none.fl_str_mv Universidad Complutense de Madrid
dc.source.none.fl_str_mv reponame:Docta Complutense
instname:Universidad Complutense de Madrid (UCM)
instname_str Universidad Complutense de Madrid (UCM)
reponame_str Docta Complutense
collection Docta Complutense
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.300719

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