Diagnosis – Invasive

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  • Coronary artery disease is associated with high mortality and morbidity rates. Traditionally, invasive coronary physiological assessment has focused on the epicardial coronary artery. More recently, appreciation of the importance of the coronary microvasculature in determining patient outcomes has grown.

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    Coronary artery disease is associated with high mortality and morbidity rates. Traditionally, invasive coronary physiological assessment has focused on the epicardial coronary artery. More recently, appreciation of the importance of the coronary microvasculature in determining patient outcomes has grown.

    An accurate diagnostic assessment during heart catheterisation has a fundamental role in prognostic stratification and treatment choices. Coronary angiography has been integrated with intravascular imaging modalities (intravascular ultrasound and optical coherence tomography) to allow the precise quantification of the atherosclerotic burden of coronary arteries. The hemodynamic relevance of a given coronary stenosis can be assessed using stress or resting indexes: fractional flow reserve and instantaneous wave-free ratio are both coronary flow surrogates, used to guide percutaneous coronary interventions.

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