Physiological assessment of coronary artery disease plays a key role in guiding myocardial revascularization, with robust evidence backing the use of fractional flow reserve (FFR) and other pressure-based indexes. Angiography has its limitations in the assessment of the severity of lesions. The extent of luminal or diameter stenosis does not always correlate with the hemodynamic significance of the lesion. It has been established that physiology is appropriate in patients with angiographically intermediate stenoses. To guide the decision to proceed with revascularization, apart from FFR, intravascular imaging (IVI) (optical coherence tomography and intravascular ultrasound) and invasive coronary testing are recommended as a class I recommendation. Update in coronary physiology includes an overview of coronary physiology techniques such as computed tomography-based physiology, pressure wire-based physiology, angiography-based physiology, and IVI-based physiology. It also offers functional assessment of coronary arteries before percutaneous coronary intervention (PCI), during, and after PCI.

Maria Jyothi is a distinguished medical professional affiliated with Apollo Hospitals, Bengaluru, India, bringing a wealth of clinical expertise and academic knowledge to the field.