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The new role of diagnostic angiography in coronary physiological assessment
  1. Mina Ghobrial1,
  2. Hazel Arfah Haley1,
  3. Rebecca Gosling1,2,
  4. Vignesh Rammohan1,3,
  5. Patricia V Lawford1,3,
  6. D Rod Hose1,3,
  7. Julian P Gunn1,2,3,
  8. Paul D Morris1,2,3
  1. 1Mathematical Modellling in Medicine, Department of Infection Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, UK
  2. 2Department of Cardiology, Sheffield Teaching Hospitals, Sheffield, UK
  3. 3Insigneo, In Silico Medicine, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Paul D Morris, Sheffield, UK; paul.morris{at}sheffield.ac.uk

Abstract

The role of ‘stand-alone’ coronary angiography (CAG) in the management of patients with chronic coronary syndromes is the subject of debate, with arguments for its replacement with CT angiography on the one hand and its confinement to the interventional cardiac catheter laboratory on the other. Nevertheless, it remains the standard of care in most centres. Recently, computational methods have been developed in which the laws of fluid dynamics can be applied to angiographic images to yield ‘virtual’ (computed) measures of blood flow, such as fractional flow reserve. Together with the CAG itself, this technology can provide an ‘all-in-one’ anatomical and functional investigation, which is particularly useful in the case of borderline lesions. It can add to the diagnostic value of CAG by providing increased precision and reduce the need for further non-invasive and functional tests of ischaemia, at minimal cost. In this paper, we place this technology in context, with emphasis on its potential to become established in the diagnostic workup of patients with suspected coronary artery disease, particularly in the non-interventional setting. We discuss the derivation and reliability of angiographically derived fractional flow reserve (CAG-FFR) as well as its limitations and how CAG-FFR could be integrated within existing national guidance. The assessment of coronary physiology may no longer be the preserve of the interventional cardiologist.

  • cardiac catheterisation
  • coronary angiography
  • computed tomography angiography
  • coronary artery disease
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Footnotes

  • Twitter @drmorriscardio

  • Contributors MG, PDM and JG are the primary authors of the work. HAH, RG, VR and PVL and DRH have made significant contributions in editing the manuscript.

  • Funding MG and HAH are funded by the British Heart Foundation (BHF TG/19/1/3445). PDM is funded by a Wellcome Trust Career Development Award (214567/Z/18/Z). The VIRTUheart workflow has been developed through grants from the Wellcome Trust-Department of Health HICF fund (HICF-R6-365) and National Institute for Health Research i4i (II-LB-0216–20006).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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