Imaging and Physiology in Coronary Artery Disease Assessment: Current Perspectives

1/5 https://e-jci.orgCoronary artery disease (CAD) remains the leading cause of morbidity and mortality in developed countries, posing a challenge to global healthcare systems.Given its widespread impact, considerable efforts have been made to increase diagnostic accuracy and therapeutic effectiveness.Over recent decades, advancements in assessment techniques and treatment strategies have significantly improved the detection, characterization, and management of CAD, ultimately resulting in better patient outcomes and reductions in cardiovascular-related morbidity and mortality. 1fective CAD management begins with precise and individualized risk assessment, which is essential in guiding treatment decisions.By stratifying risk, clinicians can identify patients who are more likely to experience adverse cardiovascular events and appropriately tailor medications or interventions.CAD risk assessment can be categorized into 2 primary approaches: physiology-based and imaging-based assessments.Physiology-based assessment focuses on evaluating the functional impact of CAD through analysis of myocardial blood flow, ischemia, and related markers.Common methods include stress testing, which can involve exercise electrocardiography, stress echocardiography, or myocardial perfusion imaging.Additionally, fractional flow reserve (FFR) and other pressure-derived indices provide quantitative insights into the hemodynamic significance of coronary stenosis, aiding decision-making regarding revascularization in the cardiac catheterization laboratory.In contrast, imaging-based assessment provides direct visualization of the coronary artery anatomy, enabling identification of atherosclerotic plaques, stenotic lesions, plaque characteristics, and vascular remodeling.Invasive coronary angiography remains the gold standard for defining coronary anatomy, while non-invasive modalities such as coronary computed tomography angiography (CCTA) have become valuable tools for early detection and risk stratification.Furthermore, intravascular imaging techniques, including intravascular ultrasound (IVUS) and optical coherence tomography, deliver high-resolution images that improve our understanding of plaque morphology and assist in guiding interventional procedures.