Physiological assessment of left main coronary artery disease

Bhavik N Modi; Tim P van de Hoef; Jan J Piek; Divaka Perera

doi:10.4244/EIJ-D-17-00135

Physiological assessment of left main coronary artery disease

Bhavik N Modi, Tim P van de Hoef, Jan J Piek, Divaka Perera

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

The left main coronary artery (LMCA) is responsible for supplying the majority of the left ventricular myocardium. Visual estimation of stenosis severity on angiography has major limitations and methods to assess functional significance, such as fractional flow reserve (FFR), have been shown to yield better outcomes; however, to date, major trials examining the use of such physiological indices have excluded LMCA disease. Furthermore, LMCA disease commonly co-exists with downstream disease, which complicates the interpretation of coronary physiological data. This review summarises existing evidence for physio-‌logy-guided management of LMCA disease. It will also explore the difficulties posed when functionally assessing LMCA lesions and outline potential solutions. Finally, we aim to provide insight into how novel physiological tools may improve the management of LMCA disease in the future.

Original language	English
Pages (from-to)	820-827
Number of pages	8
Journal	EuroIntervention
Volume	13
Issue number	7
DOIs	https://doi.org/10.4244/EIJ-D-17-00135
Publication status	Published - 20 Sept 2017
Externally published	Yes

Keywords

Constriction, Pathologic/diagnosis
Coronary Artery Disease/diagnosis
Coronary Circulation/physiology
Coronary Stenosis/physiopathology
Coronary Vessels/physiopathology
Fractional Flow Reserve, Myocardial/physiology
Humans

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title = "Physiological assessment of left main coronary artery disease",

abstract = "The left main coronary artery (LMCA) is responsible for supplying the majority of the left ventricular myocardium. Visual estimation of stenosis severity on angiography has major limitations and methods to assess functional significance, such as fractional flow reserve (FFR), have been shown to yield better outcomes; however, to date, major trials examining the use of such physiological indices have excluded LMCA disease. Furthermore, LMCA disease commonly co-exists with downstream disease, which complicates the interpretation of coronary physiological data. This review summarises existing evidence for physio-‌logy-guided management of LMCA disease. It will also explore the difficulties posed when functionally assessing LMCA lesions and outline potential solutions. Finally, we aim to provide insight into how novel physiological tools may improve the management of LMCA disease in the future.",

keywords = "Constriction, Pathologic/diagnosis, Coronary Artery Disease/diagnosis, Coronary Circulation/physiology, Coronary Stenosis/physiopathology, Coronary Vessels/physiopathology, Fractional Flow Reserve, Myocardial/physiology, Humans",

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year = "2017",

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doi = "10.4244/EIJ-D-17-00135",

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AU - Modi, Bhavik N

AU - van de Hoef, Tim P

AU - Piek, Jan J

AU - Perera, Divaka

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Y1 - 2017/9/20

N2 - The left main coronary artery (LMCA) is responsible for supplying the majority of the left ventricular myocardium. Visual estimation of stenosis severity on angiography has major limitations and methods to assess functional significance, such as fractional flow reserve (FFR), have been shown to yield better outcomes; however, to date, major trials examining the use of such physiological indices have excluded LMCA disease. Furthermore, LMCA disease commonly co-exists with downstream disease, which complicates the interpretation of coronary physiological data. This review summarises existing evidence for physio-‌logy-guided management of LMCA disease. It will also explore the difficulties posed when functionally assessing LMCA lesions and outline potential solutions. Finally, we aim to provide insight into how novel physiological tools may improve the management of LMCA disease in the future.

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KW - Coronary Artery Disease/diagnosis

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KW - Coronary Stenosis/physiopathology

KW - Coronary Vessels/physiopathology

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Physiological assessment of left main coronary artery disease

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Keywords

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