Intracoronary physiology testing has emerged as a valuable diagnostic approach in the management of patients with chronic coronary syndrome, circumventing limitations like inferring coronary function from anatomical assessment and low spatial resolution associated with angiography or non-invasive tests. The value of hyperaemic translesional pressure ratios to estimate the functional relevance of coronary stenoses is supported by a wealth of prognostic data. The continuing drive to further simplify this approach led to the development of non-hyperaemic pressure-based indices. Recent attention has focussed on estimating physiology without even measuring coronary pressure. However, the reduction in procedural time and ease of accessibility afforded by these simplifications needs to be counterbalanced against the increasing burden of physiological assumptions, which may impact on the ability to reliably identify an ischaemic substrate, the ultimate goal during catheter laboratory assessment. In that regard, measurement of both coronary pressure and flow enables comprehensive physiological evaluation of both epicardial and microcirculatory components of the vasculature, although widespread adoption has been hampered by perceived technical complexity and, in general, an underappreciation of the role of the microvasculature. In parallel, entirely non-invasive tools have matured, with the utilization of various techniques including computational fluid dynamic and quantitative perfusion analysis. This review article appraises the strengths and limitations for each test in investigating myocardial ischaemia and discusses a comprehensive algorithm that could be used to obtain a diagnosis in all patients with angina scheduled for coronary angiography, including those who are not found to have obstructive epicardial coronary disease.

中文翻译：

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慢性冠状动脉综合征缺血的侵入性和非侵入性评估：将病理生理学转化为临床实践

冠状动脉内生理学测试已成为治疗慢性冠状动脉综合征患者的一种有价值的诊断方法，避免了从解剖评估推断冠状动脉功能和与血管造影或非侵入性测试相关的低空间分辨率等限制。大量预后数据支持通过充血跨病灶压力比来估计冠状动脉狭窄的功能相关性的价值。进一步简化这种方法的持续推动导致了基于非高血压的指数的发展。最近的注意力集中在估计生理学上，甚至不测量冠状动脉压力。然而，这些简化带来的程序时间减少和可及性需要与生理假设负担的增加相平衡，这可能会影响可靠识别缺血性基质的能力，这是导管实验室评估的最终目标。在这方面，冠状动脉压力和流量的测量能够对脉管系统的心外膜和微循环成分进行全面的生理评估，尽管普遍采用受到技术复杂性的阻碍，并且通常对微脉管系统的作用的认识不足。与此同时，完全非侵入性的工具已经成熟，利用了包括计算流体动力学和定量灌注分析在内的各种技术。