Individualisierte Diagnostik und Therapie im Herzkatheterlabor: wann Funktionsdiagnostik oder Bildgebung?

Zusammenfassung

Die Koronarangiografie stellt nach wie vor den Goldstandard bei der Diagnostik der koronaren Herzerkrankung dar. Ihre Limitationen in Bezug auf die Evaluation prognostischer Bedeutung intermediärer Stenosen oder die morphologische Beurteilung komplexer Läsionen haben zur Entwicklung invasiver physiologischer Messungen sowie der intravaskulären Bildgebung geführt. Sowohl die Funktionsdiagnostik als auch die intrakoronare Bildgebung sind aus der modernen interventionellen Kardiologie nicht mehr wegzudenken und helfen bei der Auswahl von Patienten für eine Revaskularisierung und bei der Optimierung der perkutanen Koronarintervention. Das pathophysiologische Zusammenspiel zwischen der hämodynamischen Relevanz und der Plaquemorphologie bietet einen Mehrwert für die Festlegung der diagnostischen Strategie, was individuell vom behandelnden Kardiologen beurteilt werden muss.

Abstract

Coronary angiography remains the gold standard in the diagnosis of coronary artery disease (CAD). Its limitations with regard to the evaluation of the prognostic significance of intermediate stenoses or morphological assessment of complex lesions have led to the development of invasive physiological measurements and intravascular imaging. Both methods have become indispensable in modern interventional cardiology and help in the selection of patients for revascularization, and with PCI optimization. The pathophysiological interplay between hemodynamic status and plaque morphology can offer added value for one or the other diagnostic strategy, but this must be assessed individually by the treating cardiologist.

Was ist wichtig?

• Die Koronarangiografie stellt der Goldstandard in der invasiven Diagnostik der koronaren Herzkrankheit dar, entspricht jedoch einem Luminogramm und erlaubt weder die physiologische Beurteilung der hämodynamischen Relevanz von Koronarstenosen noch die Charakterisierung der Plaquemorphologie.

• Methoden der invasiven Funktionsdiagnostik, FFR (fraktionierte Flussreserve) und iFR (Instantaneous Wave-free Ratio) geben wichtige Rückschlüsse auf die Relevanz intermediärer Stenosen und helfen bei der Entscheidungsfindung für oder gegen Revaskularisierung.

• Die intravaskuläre Bildgebung erlaubt die genaue morphologische Beurteilung höhergradiger Koronarstenosen, steuert Interventionen und ermöglicht die Ergebnisoptimierung.

• Die Frage, „wann Funktionsdiagnostik oder Bildgebung“ verwendet werden sollen, kann nur individuell beantwortet werden und hängt von einer Vielzahl an Faktoren ab.

Schlüsselwörter

intravaskulärer Ultraschall - fraktionierte Flussreserve - optische Kohärenztomografie

Keywords

intravascular ultrasound - optical coherence tomography - fractional flow reserve

Publication History

Article published online:
02 April 2025

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