RATIONALE AND APPLICATION OF CORONARY TRANSSTENOTIC PRESSURE-GRADIENTMEASUREMENTS

Presence, extent, and evolution of atherosclerotic coronary narrowings , as well as the anatomic possibilities for revascularization, can be reliably defined at (and only at) selective coronary angiography. The latter remains, therefore, the pivotal diagnostic tool for patients wi th suspected coronary artery disease. However, in spite of the increas ing availability of on-line quantitative coronary angiography, it stil l holds that the functional (physiologic) consequences of an epicardia l coronary narrowing cannot be completely derived from geometric (anat omic) information. Clinical decision making can be particularly diffic ult in lesions of intermediate severity (40-70% diameter reduction), i n postinterventional segments, and in some particular anatomic setting s, namely, ostial stenoses, bifurcation lesions, and diffuse atheroscl erotic disease. This has led to an explosive growth of new methods for assessing the physiological significance of coronary narrowings docum ented at angiography. Among them, Doppler blood flow velocitometry and transstenotic pressure gradient measurements have emerged as the only techniques easily applicable in most catheterization laboratories. He re, we briefly review the clinical interest of measuring transstenotic pressure gradients. (C) 1994 Wiley-Liss, Inc.