Intracoronary Imaging And Physiology

This book is intended as a guide for all cardiologists who are interested in coronary imaging and physiology, a sound understanding of which is vital for the optimal performance of appropriate coronary interventions. The basics of each relevant modality are presented, with clear explanation of clinical utility and evaluation of the evidence regarding clinical outcomes. All technical methods are described in detail, and the text is complemented by numerous helpful tables and illustrations. The effectiveness of intravascular coronary imaging in improving clinical outcomes is proven, and it is widely used for this purpose. Two modalities for intravascular coronary imaging are available in clinical practice: intravascular ultrasound (IVUS) and optical coherence tomography (OCT). For coronary physiology, the pressure wire-derived fractional flow reserve (FFR) provides information on the functional status of coronary trees. This technique and its clinical applications receive particular attention in the book, which also looks beyond FFR to FFR-CT, a method using computational fluid dynamics, and to invasive assessment of the microcirculation.

In this issue of Interventional Cardiology Clinics, guest editor Dr. Allen Jeremias brings his considerable expertise to the topic of Intracoronary Physiology and Its Use in Interventional Cardiology. Assessment of intra-coronary physiology can guide percutaneous coronary intervention and is often used for angiographically borderline stenoses. There is now increasing evidence to suggest that more routine use can improve clinical outcomes. In this issue, top experts bring you fully up to date in this key area of interventional cardiology. Contains 13 practice-oriented topics including updates in coronary physiology: what about all the negative trials?; physiology for post-PCI assessment; physiology and intravascular imaging co-registration; CT-derived physiology assessment; targeted therapies for microvascular disease; and more. Provides in-depth clinical reviews on intracoronary physiology and its use in interventional cardiology, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

​Since the introduction of coronary angiography, a key technique in understanding coronary artery disease, a number of paradigms regarding its study and interpretation have taken place. Following an emphasis on improved angiographic and subsequent intracoronary imaging techniques, functional assessment of coronary circulation has demonstrated to have major implications for diagnosis and treatment of coronary artery disease. Fractional flow reserve, a pressure derived index of stenosis severity, constitutes the best example of the current importance of physiological assessment in clinical practice. However, the acceptance of FFR by cardiologists contrasts with important voids in knowledge on the basic principles of coronary physiology and of other available techniques that, as an alternative to FFR, allow a more comprehensive assessment of coronary circulation. This is particularly noticeable in the assessment of microcirculation, an unavoidable compartment of coronary circulation that is frequently affected in acute coronary syndromes of in the presence of cardiovascular risk factors or non-coronary heart disease. A deeper understanding of the relationship between epicardial vessel and microcirculatory involvement has started with the advent of newer imaging techniques like invasive optical coherence tomography, and non-invasive CT and NMR techniques. This book aims to be an indispensable tool for clinicians and researches in the field of coronary artery disease. It provides a balanced, comprehensive review of anatomy, physiology and available techniques, discusses both the diagnosis of epicardial vessel and microcirculatory disease, the impact of different diseases at different levels of coronary circulation, and the best way to address a separate or combined assessment of different levels of coronary circulation. ​

In this issue of Interventional Cardiology Clinics, guest editor Dr. Allen Jeremias brings his considerable expertise to the topic of Intracoronary Physiology and Its Use in Interventional Cardiology. Assessment of intra-coronary physiology can guide percutaneous coronary intervention and is often used for angiographically borderline stenoses. There is now increasing evidence to suggest that more routine use can improve clinical outcomes. In this issue, top experts bring you fully up to date in this key area of interventional cardiology. Contains 13 practice-oriented topics including updates in coronary physiology: what about all the negative trials?; physiology for post-PCI assessment; physiology and intravascular imaging co-registration; CT-derived physiology assessment; targeted therapies for microvascular disease; and more. Provides in-depth clinical reviews on intracoronary physiology and its use in interventional cardiology, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

This issue of Interventional Cardiology Clinics, edited by Allen Jeremias, is devoted to Intravascular Physiology. Dr. Jeremias assembled a group of expert contributors to review the following topics: Evolution of Coronary Physiology – Basic Concepts of FFR and CFR; Concept of "Functional PCI" – The Rational for Physiologic Lesion Assessment for PCI Guidance; Limitations and Pitfalls of FFR and Adenosine-Induced Hyperemia; Evidence for the Use of FFR to Guide Clinical Decision-Making – The Landmark FFR Clinical Trials; Evaluation of Microvascular Disease and Clinical Outcomes; Hyperemic vs. Resting Indices for the Assessment of CAD; FFR for the Evaluation of Tandem and Bifurcations Lesions, Left Main, and Acute Coronary Syndromes; and CT-FFR: Basic Concept and Clinical Implementation.

Incorporating 20 years of clinical, physiologic and technological research, this book develops the scientific basis for new approaches to the diagnosis and management of symptomatic and asyptomatic coronary atherosclerosis.