When coronary imaging and physiology are discordant, how best to manage coronary lesions? An appraisal of the clinical evidence

• Published in: Catheterization and cardiovascular interventions 2022-06, Vol.99 (7), p.2008-2015
• Main Authors: Fernández‐Peregrina, Estefania, Ahmad, Huzaifa, Mintz, Gary S., Garcia‐Garcia, Hector M.
• Format: Article
• Language: English
• Subjects: Anatomy; Anatomy & physiology; Angiography; coronary artery disease; coronary blood flow/physiology/microvascular function; fractional flow reserve; imaging angiographic/fluoroscopic; intravascular ultrasound; Ischemia; Lesions; optical coherence tomography; Physiology; Stenosis
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30186

Background Discordant physiology and anatomy may occur when nonsevere angiographic stenosis has positive physiology as well as the opposite situation. Aim To underline the reasons behind the discrepancy in physiology and anatomy and to summarize the information that coronary imaging may add to physiology. Methods A review of the published literature on physiology and intravascular imaging assessment of intermediate lesions was carried out. Results The limitations of angiography, the possibility of an underlying diffuse disease, the presence of a “grey zone” in both techniques, the amount of myocardial mass that subtends the stenosis, and plaque vulnerability may play a role in such discrepancy. Intracoronary imaging has a poor diagnostic accuracy compared to physiology. However, it may add information about plaque vulnerability that might be useful in deciding whether to treat or not a certain lesion. Conclusions Coronary revascularization is recommended for patients with ischemia based on physiology. Intracoronary imaging adds information on plaque vulnerability and can help on the decision whether to revascularize or not a lesion.