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This editorial refers to ‘Three-dimensional and two-dimensional quantitative coronary angiography, and their prediction of reduced fractional flow reserve’, by A.S.C. Yong et al. doi:10.1093/eurheartj/ehq259 ‘Oculo-stenotic reflex’ is a term which ridicules the variably developed attraction of interventional cardiologists to ‘seal’ coronary atherosclerotic bumps by balloon angioplasty. Its serious template relates to their daily business of estimating the functional relevance of a coronary stenosis by its structure. It is well known that even the experienced interventionalist may be ‘lost in translation’ when it comes to judging intermediate severity stenoses.1 Long before the development of intracoronary sensor guidewires for functional stenosis assessment, attempts were made to improve the structure–function translation by quantitative coronary angiography (QCA) as obtained in two (2D), but also as reconstructed in three dimensions (3D).2,3 The two principles of any coronary structure–function translation are (i) statistical comparison of single, physically important structural stenosis elements with a functional reference; and (ii) the mathematical integration of stenosis' geometric hallmarks to a single measure with subsequent statistical reference comparison.Ideally, both approaches would have to anticipate all the geometric patterns of a coronary atherosclerotic lesion, because it is the composite of all its finite structural elements which determines the drop in flow or perfusion pressure. Thus, the method would be aiming at a disorder's concept (i.e. recognition of how exactly and variably the epicardial stenoses grow in coronary artery disease; CAD). In philosophical terms, ‘a disorder's concept’ is an oxymoron and, therefore, pointing at it probably unsuccessful. In geometrical terms and as outlined below, it is challenging to model the structural elements of a stenosis accurately into a haemodynamic parameter.Notwithstanding these considerations, Yong and co-workers have observed, on a purely statistical basis, 2D- and 3D-QCA parameters and compared them with coronary pressure-derived fractional flow reserve (FFR) as … *Corresponding author. Tel: 41 31 632 36 93, Fax: +41 31 632 42 99, Email: christian.seiler{at}insel.ch

Aiming at a disorder's concept by 3D QCA vs. FFR: a case of advanced ballistics