Canadian first brings new precision to heart disease treatment

HN Summary

• Southlake Health is the first hospital in Canada to perform Pullback Pressure Gradient (PPG) analysis, an advanced procedure that helps physicians better assess coronary artery disease and personalize treatment decisions.

• By distinguishing between focal and diffuse coronary disease, PPG enables clinicians to identify which patients are most likely to benefit from stenting, medication or surgery, improving precision and outcomes. 

• The milestone reinforces Southlake’s leadership in cardiac innovation and its role as one of Ontario’s largest regional cardiac programs, delivering world-class heart care closer to home.

Southlake Health has reached another milestone in Canadian cardiac care, becoming the first hospital in the country to perform a Pullback Pressure Gradient (PPG) analysis of a coronary artery—a breakthrough that is helping physicians make more precise treatment decisions for patients with coronary artery disease.

The first-of-its-kind procedure, led by interventional cardiologist Dr. Steven Miner and the team at Southlake’s Regional Cardiac Program, marks a significant advancement in coronary physiology. By providing a more detailed understanding of how blockages affect blood flow, PPG analysis helps determine not only whether a patient requires an intervention, but also whether a stent is the most appropriate treatment.

“This technology represents a major advancement in how we evaluate and treat coronary artery disease,” says Dr. Miner. “Traditionally, physicians have relied on measurements that tell us whether blood flow is reduced. PPG goes a step further by helping us understand the pattern of disease within the artery and whether intervention is truly the best option for the patient. It helps us make smarter, more informed decisions and ensures we are treating the right problem, in the right way, for the right patient.”

Moving beyond traditional assessment

Coronary artery disease (CAD) remains the most common form of heart disease in Canada and is the country’s second leading cause of death. The condition develops when plaque builds up inside the coronary arteries, restricting blood flow to the heart and increasing the risk of chest pain, heart attack, heart failure and other serious cardiovascular complications.

While advances in diagnosis and treatment have improved outcomes, physicians have long sought more sophisticated tools to determine which patients will benefit most from intervention.

For years, Fractional Flow Reserve (FFR) has been the gold standard for assessing blood flow through narrowed coronary arteries. FFR measures pressure differences across a blockage to determine whether reduced blood flow is severe enough to require treatment.

PPG builds on that foundation by offering a more comprehensive picture.

Rather than simply identifying whether blood flow is restricted, PPG analysis reveals how disease is distributed within the artery. It distinguishes between focal disease, where a single blockage is responsible for limiting blood flow, and diffuse disease, where plaque is spread throughout the vessel.

That distinction has important implications for patient care.

Patients with focal disease often experience significant benefit from Percutaneous Coronary Intervention (PCI), commonly performed by placing a coronary stent. In contrast, patients with diffuse disease may achieve better outcomes through medication or coronary artery bypass surgery rather than stenting.

By identifying both the pattern of disease and the location where treatment would have the greatest benefit, PPG allows physicians to deliver care that is tailored to each patient’s unique physiology.

A Canadian first

Earlier this year, Dr. Miner and his team became the first in Canada to perform the procedure using the CoroFlow Cardiovascular System together with Abbott’s PressureWire X Guidewire.

The wireless guidewire measures pressure and temperature throughout the coronary artery in real time, allowing physicians to create a detailed physiological map of blood flow. When combined with PPG analysis, clinicians can determine whether an intervention is likely to improve outcomes and precisely where treatment should be directed.

The technology represents an important shift toward physiology-guided cardiac care—using functional information about blood flow rather than relying solely on imaging to guide treatment decisions.

“It’s inspiring to see Canadian clinicians leading the way in adopting advanced coronary physiology techniques,” says Dr. Ethan Korngold, Chief Medical Officer for Abbott’s vascular business. “Southlake Health’s first-in-Canada use of PPG analysis underscores how innovation, when paired with clinical expertise, can unlock deeper insights into complex coronary disease and help deliver more precise, personalized patient care.”

Delivering world-class cardiac care close to home

Southlake’s achievement reflects the growing role regional cardiac centres are playing in advancing specialized cardiovascular care across Ontario.

As a Level 7 Regional Cardiac Program, Southlake provides nearly every aspect of cardiac care—everything from emergency heart attack treatment and advanced coronary interventions to structural heart procedures and complex cardiac surgery—eliminating the need for many patients across York Region, Simcoe County and Muskoka to travel to Toronto for treatment.

The Regional Cardiac Program is the fourth-largest comprehensive heart program in Ontario and serves as the regional hub for emergency heart attack care, ensuring patients experiencing a heart attack receive rapid access to specialized treatment regardless of which hospital is closest.

Innovation has become a defining characteristic of the program.

Southlake physicians regularly participate in international clinical research and have been among the first in Ontario, Canada and globally to introduce new cardiovascular procedures and technologies. Last year, Dr. Miner and his team were selected to perform a live case demonstration at the Transcatheter Cardiovascular Therapeutics (TCT) Conference, the world’s premier meeting for interventional cardiology. In 2024, Dr. Miner was also named co-chair of the U.S.-based Microvascular Network Physician Education Committee, helping share Southlake’s expertise with cardiovascular specialists around the world.

The future of personalized heart care

As Canada’s population continues to grow and age, coronary artery disease will remain one of the country’s greatest health challenges. Technologies such as Pullback Pressure Gradient analysis are helping move cardiac care toward a more personalized approach—one that better matches treatment to each patient’s specific pattern of disease.

Rather than asking only whether an artery is narrowed, physicians can now better understand why blood flow is impaired and whether intervention is likely to provide meaningful benefit.

For patients, that means fewer unnecessary procedures, more targeted treatments and greater confidence that the care they receive is tailored to their individual condition.

With its first-in-Canada use of PPG analysis, Southlake Health continues to demonstrate how innovation, clinical expertise and research can work together to improve patient outcomes while ensuring advanced cardiac care remains available closer to home.

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