Physiological Assessment of Coronary Stenoses and the Microcirculation

Since the introduction of coronary angiography, a key technique in understanding coronary artery disease, a number of paradigms regarding its study and interpretation have taken place. Following an emphasis on improved angiographic and subsequent intracoronary imaging techniques, functional assessment of coronary circulation has demonstrated to have major implications for diagnosis and treatment of coronary artery disease.  Fractional flow reserve, a pressure derived index of stenosis severity, constitutes the best example of the current importance of physiological assessment in clinical practice. However, the acceptance of FFR by cardiologists contrasts with important voids in knowledge on the basic principles of coronary physiology and of other available techniques that, as an alternative to FFR, allow a more comprehensive assessment of coronary circulation. This is particularly noticeable in the assessment of microcirculation, an unavoidable compartment of coronary circulation that is frequently affected in acute coronary syndromes of in the presence of cardiovascular risk factors or non-coronary heart disease. A deeper understanding of the relationship between epicardial vessel and microcirculatory involvement has started with the advent of newer imaging techniques like invasive optical coherence tomography, and non-invasive CT and NMR techniques. This book aims to be an indispensable tool for clinicians and researches in the field of coronary artery disease. It provides a balanced, comprehensive review of anatomy, physiology and available techniques, discusses both the diagnosis of epicardial vessel and microcirculatory disease, the impact of different diseases at different levels of coronary circulation, and the best way to address a separate or combined assessment of different levels of coronary circulation.  ​

Javier Escaned MD PhD FESC is Head of Section (Interventional Cardiology) at Hospital Clinico 

San Carlos, and Associate Professor of Medicine at Complutense University (Madrid, Spain). He 

trained as a cardiologist the United Kingdom (Queen Elizabeth University Hospital, Birmingham 

and Walsgrave Hospital, Coventry) before moving to the Thoraxcenter / Rotterdam (The 

Netherlands), where he obtained his PhD degree in 1994. He is author of more than 250 scientific 

articles, books and book chapters on different aspects of interventional cardiology, imaging and 

physiology. He is co-editor with Patrick Serruys of the textbook “Coronary Stenosis. Imaging, 

Structure and Physiology”, whose new edition was launched in May 2015. Current positions in 

scientific societies include: board member (treasurer) of European Association of Percutaneous 

Cardiovascular Interventions (EAPCI), nucleus member of the ESC Working Group on 

Pathophysiology and Microcirculation, and co-director of EuroPCR. In 2014 he served as director of 

the ESC International Summit on Coronary Microcirculation and Heart Disease. Recent or on-going 

international multicentre trials in which he has a principal investigator role include: ADVISE II, 

SYNTAX II, PILOT SECRET, SHEAR STENT and DEFINE-FLAIR. Some of his additional 

interests are philosophy, education and music.