The Evolution of Virtual Physiologic Assessments and Virtual Coronary Intervention to Optimize Revascularization

• Published in: Current cardiovascular imaging reports Vol. 14; no. 4
• Main Authors: Stout, Kara M., Boudoulas, Kostantinos D., Povsic, Thomas J., Altin, S. Elissa, Jhand, Aravdeep S., Bailey, Steven R., Goldsweig, Andrew M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2021; Springer Nature B.V
• Subjects: Angiography; Assessments; Cardiology; Cardiovascular disease; Coronary artery disease; Decision making; Diagnostic Radiology; Imaging; Interventional Radiology; Intravascular Imaging (A.G. Truesdell; Medicine; Medicine & Public Health; Nuclear Medicine; Pressure ratio; Radiology; Section Editor; Topical Collection on Intravascular Imaging; Ultrasound; Wire; coronary angiography–derived fractional flow reserve; Virtual physiologic assessment; VCI (virtual coronary intervention); FFR; cFFR (virtual contrast FFR); vFFR (virtual fractional flow reserve); QFR (quantitative flow reserve)
• ISSN: 1941-9066; 1941-9074
• DOI: 10.1007/s12410-021-09554-6

Purpose of Review In this review, we summarize the use of virtual physiologic functional assessments of coronary artery disease and their utility to guide virtual coronary intervention (VCI). Recent Findings Virtual fractional flow reserve (vFFR), coronary angiography–derived fractional flow reserve (FFR angio ), virtual contrast FFR (cFFR), and quantitative flow reserve (QFR) are four technologies that generate computer-based FFR measurements comparable to the gold standard of pressure-wire-based FFR. VCI capitalizes on this technology by utilizing pre- and post-vFFR assessments to predict the physiologic response to stenting. Summary Physiologic assessment of coronary lesion significance has become a cornerstone of decision-making for revascularization. FFR and non-hyperemic pressure ratio use is limited by the requirement for an intracoronary wire and the additional time required. Virtual physiologic assessments address these shortcomings with accuracy comparable to FFR. Building on this technology, VCI simulation has the potential to revolutionize the approach to percutaneous revascularization.