Intracoronary pressure and flow velocity for hemodynamic evaluation of coronary stenoses

Adequate patient selection for percutaneous coronary intervention is of utmost importance to minimize early and late complications. Consequently, objective evidence for myocardial ischemia is mandatory for the management of patients with coronary artery disease, in particular in multivessel disease and intermediate lesions (40-70% diameter stenosis on angiography). The use of sensor-equipped guide wires for the assessment of functional coronary lesion severity has become widespread in the catheterization laboratory. The indices derived from pressure or flow measurements, fractional flow reserve, coronary flow velocity reserve and relative coronary flow velocity reserve show a high agreement with noninvasive stress testing. However, while these indices are based on either intracoronary pressure or flow, they do not investigate the hemodynamics of the coronary circulation entirely, leading to ambiguous outcomes. Only the use of simultaneously measured pressure and flow will avoid any possible misinterpretation of the data.