Wave intensity analysis for evaluation of coronary artery disease beyond traditional coronary hemodynamics Pathophysiology of cardiac-coronary coupling

This thesis aims to examine the pathophysiology of cardiac–coronary coupling comprehensively using wave intensity analysis (WIA). WIA quantifies coronary wave intensity by acquiring intracoronary pressure and Doppler velocity signals simultaneously, rather than relying on traditional time-averaged and isolated indices from either modality alone. The study explores the potential applications of WIA in chronic coronary syndromes (CCS), which encompass epicardial stenoses and coronary microvascular dysfunction. The goal is to enhance our understanding of the underlying disease mechanisms and to identify novel diagnostic and prognostic markers. In addition to proposing new diagnostic parameters, the thesis addresses key inconsistencies in coronary physiology, such as the discrepancy between pressure and flow measurements and the limited prognostic value of high microvascular resistance in CCS. Contemporary tools, including reservoir–excess pressure parameters, are also used to evaluate coronary pathophysiology in relation to aortic haemodynamics.