Fractional flow reserve

2021 ◽  
pp. 63-67
Author(s):  
Giovanni Ciccarelli ◽  
Emanuele Barbato ◽  
Bernard De Bruyne
Keyword(s):  
Blood Flow ◽  
Myocardial Blood Flow ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Coronary Intervention ◽  
Aortic Pressure ◽  
Fractional Flow ◽  
Coronary Pressure ◽  
Flow Reserve ◽  
Percutaneous Coronary

Fractional flow reserve is an index of the physiological significance of a coronary stenosis, defined as the ratio of maximal myocardial blood flow in the presence of the stenosis to the theoretically normal maximal myocardial blood flow (i.e. in the absence of the stenosis). This flow ratio can be calculated from the ratio of distal coronary pressure to central aortic pressure during maximal hyperaemia. More practically, fractional flow reserve indicates to what extent the epicardial segment can be responsible for myocardial ischaemia and, accordingly, fractional flow reserve quantifies the expected perfusion benefit from revascularization by percutaneous coronary intervention. Very limited evidence exists on the role on fractional flow reserve for bypass grafts.

Functional coronary assessment: fractional flow reserve

ESC CardioMed ◽  
2018 ◽  
pp. 640-643
Author(s):  
Emanuele Barbato ◽  
Fabio Mangiacapra
Keyword(s):  
Blood Flow ◽  
Fractional Flow Reserve ◽  
Coronary Revascularization ◽  
Threshold Value ◽  
Aortic Pressure ◽  
Multivessel Disease ◽  
Fractional Flow ◽  
Transcatheter Aortic Valve ◽  
Coronary Pressure ◽  
Flow Reserve

Fractional flow reserve (FFR) is the invasive standard of reference in identifying haemodynamically significant stenoses, those that are able to induce reversible myocardial ischaemia. Although defined as the ratio of maximum blood flow in a stenotic coronary to maximum blood flow if the same coronary would be normal, FFR is expressed as the ratio of two pressures: the distal coronary pressure measured by an intracoronary pressure guidewire and the proximal coronary or aortic pressure measured at the tip of the guiding catheter during maximal coronary hyperaemia. A threshold value of FFR less than or equal to 0.80 is currently recommended to indicate or defer coronary revascularization. In fact, a FFR-guided revascularization strategy has been shown to be safe and effective in reducing adverse events in a number of anatomical lesion subsets, including intermediate coronary stenoses, left main stenoses, multivessel disease, bifurcation lesions, sequential stenoses, stented vessels, and bypass grafts. There is growing interest in the use of FFR also in the setting of acute coronary syndrome. In patients with acute ST-elevation myocardial infarction, FFR has been adopted to assess intermediate stenoses incidentally found in non-culprit coronaries, and may be useful to guide the completeness of revascularization in the presence of multivessel disease. Finally, FFR is emerging as a novel potential area for invasive functional assessment of coronary atherosclerotic disease in patients with aortic stenosis, due to the increasing indications to transcatheter aortic valve implantation.

scholarly journals Fractional Flow Reserve Assessment of a Significant Coronary Stenosis Masked by a Downstream Serial Lesion

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Lawrence Yu-Min Liu ◽  
Hsu-Ping Wu ◽  
Po-Lin Lin
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Bolus Injection ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Serial Lesion ◽  
Coronary Lesions ◽  
Significant Coronary Stenosis

Fractional flow reserve (FFR) has been recognized as an effective tool to determine functional significance in intermediate coronary lesions and FFR-guided percutaneous coronary intervention (PCI) improves clinical outcomes. However, hemodynamic interaction between serial stenoses within one coronary artery complicates the assessment of functional severity of each individual lesion. We present a case in which FFR measurement by intracoronary bolus injection of adenosine helps to make appropriate revascularization decision in serial stenoses when the procedures are performed systemically and properly.

scholarly journals Improvement of Fractional Flow Reserve after Percutaneous Coronary Intervention Does Not Necessarily Indicate Increased Coronary Flow

2019 ◽  
Vol 14 (1) ◽  
pp. 10-12 ◽  
Author(s):  
Rikuta Hamaya ◽  
Yoshihisa Kanaji ◽  
Eisuke Usui ◽  
Masahiro Hoshino ◽  
Tadashi Murai ◽  
...  
Keyword(s):  
Blood Flow ◽  
Percutaneous Coronary Intervention ◽  
Coronary Blood Flow ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Microvascular Resistance

Coronary flow is expected to increase by epicardial lesion modification after successful percutaneous coronary intervention (PCI) in stable angina. According to the concept of fractional flow reserve (FFR), the improvement in FFR after PCI reflects the extent of coronary flow increase. However, this theory assumes that hyperaemic microvascular resistance does not change after PCI, which is being refuted in recent studies. The authors quantitated regional absolute coronary blood flow (ABF) before and after PCI using a thermodilution method and compared it with FFR in 28 patients with stable coronary artery disease who had undergone successful PCI. Although FFR indicated changes in ABF, with a mean difference of −5.5 ml/min, there was no significant relationship between individual changes in FFR and in ABF (R=0.27, p=0.16). The discrepancy was partly explained by changes in microvascular resistance following PCI. These results suggest that changes in FFR do not necessarily indicate an increase in absolute coronary blood flow following PCI in individual patients, although they could be correlated in a cohort level.

Fractional Flow Reserve: Does a Cut-off Value add Value?

2016 ◽  
Vol 11 (1) ◽  
pp. 17
Author(s):  
Shah R Mohdnazri ◽  
◽  
◽  
◽  
Thomas R Keeble ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Grey Zone ◽  
Fractional Flow ◽  
Non Invasive ◽  
Invasive Test ◽  
Flow Reserve ◽  
A Value ◽  
Percutaneous Coronary ◽  
Value Add

Fractional flow reserve (FFR) has been shown to improve outcomes when used to guide percutaneous coronary intervention (PCI). There have been two proposed cut-off points for FFR. The first was derived by comparing FFR against a series of non-invasive tests, with a value of ≤0.75 shown to predict a positive ischaemia test. It was then shown in the DEFER study that a vessel FFR value of ≥0.75 was associated with safe deferral of PCI. During the validation phase, a ‘grey zone’ for FFR values of between 0.76 and 0.80 was demonstrated, where a positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI.

scholarly journals Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: a meta-analysis

Heart ◽  
2015 ◽  
Vol 101 (6) ◽  
pp. 455-462 ◽  
Author(s):  
Dongfeng Zhang ◽  
Shuzheng Lv ◽  
Xiantao Song ◽  
Fei Yuan ◽  
Feng Xu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Fractional Flow Reserve ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary
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