Background: Contemporary management of coronary disease focuses on the treatment of
stenoses in the major epicardial vessels. However, myocardial blood flow is known to be contingent
on a range of factors in addition to the patency of the epicardial vessels. These include anatomical
and physiological factors such as the extent of myocardium supplied by the vessel, systemic blood
pressure, the natural variation in vascular tone in response to physiological needs which allows for
coronary autoregulation and pathological factors such as the presence of downstream obstruction to
flow due to disease of the small coronary vessels or myocardium. The assessment of clinical effectiveness
and adequacy of coronary revascularisation requires the ability to comprehensively and accurately
assess and measure myocardial perfusion.
Conclusion: In this article, we review the current methods of evaluating coronary blood flow and
myocardial perfusion in the cardiac catheterisation laboratory.
Keywords: Coronary physiology, microvascular resistance, coronary blood flow measurement, myocardial blood flow, autoregulation,
stenoses, epicardial vessels.
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