Intracoronary Physiology in Ischemic Heart Disease: From functional diagnosis to specific treatment strategy

The aim of this thesis entitled: “Intracoronary physiology in ischemic heart disease: from functional diagnosis to specific treatment strategy’’ was to investigate different invasive methods to evaluate the functional relevance of epicardial stenoses and microvascular disease in the setting of chronic and acute coronary syndrome. We especially focused on the interaction between epicardial and microvascular intracoronary hemodynamics and the difficulties that we are facing when invasive physiology indices are used to detect ischemic heart disease (IHD) in the presence of microvascular disease (MVD). Intracoronary physiology is used in clinical practice to assess microvascular epicardial and collateral function in chronic- (Part I) and acute coronary syndrome. A detailed look into the implementation of these invasive indices in the presence of a diseased coronary microvasculature following ST-elevation myocardial infarction (STEMI) (Part II) seems to be of imminent importance with the increasing use of intracoronary physiology to guide clinical decisions. In addition we studied the possibility of reducing coronary and peripheral microvascular dysfunction in patients with acute coronary syndrome (Part III). In this thesis we explored the use of intracoronary physiology in different subgroups of patients with IHD from functional diagnosis to optimal treatment strategy.