Fractional Flow Reserve (FFR)
Fractional Flow Reserve (FFR) is a physiological index used to assess the severity of coronary artery stenosis.
A pressure-based measurement that determines the functional significance of a coronary stenosis, Calculated as the ratio of maximal blood flow in a stenotic artery to normal maximal flow.
Who Needs?
- Patients with intermediate coronary stenosis (50-70% narrowing)
- Can be used for stenosis up to 90% in some cases
- Not typically needed for stenosis <30% or >70%
Key features:
- Performed during cardiac catheterization
- Uses a pressure wire to measure pressure differences across a stenosis
- Requires inducing maximal hyperemia, usually with adenosine
Procedure details:
- Pressure wire is advanced distal to the stenosis
- Maximal hyperemia is induced
- Pressures are measured proximal and distal to the stenosis
- FFR is calculated as the ratio of distal to proximal pressure
Advantages:
- More accurate than angiography alone in assessing functional significance
- Can reduce unnecessary interventions
- Improves clinical outcomes when used to guide treatment
- Cost-effective
Interpretation:
- Normal FFR: 0.94-1.0
- FFR ≥0.80: Generally does not require intervention
- FFR 0.75-0.80: “Grey zone”, may consider intervention
- FFR <0.75: Typically requires intervention (e.g., angioplasty and stenting)
Limitations:
- Requires pharmacological induction of hyperemia
- May be affected by microvascular dysfunction
- Potential for false normal values in certain conditions
Clinical impact:
- Recommended in guidelines for assessing intermediate lesions (Class I recommendation)
- Associated with lower rates of adverse events compared to angiography-guided PCI
- Can lead to changes in treatment strategy in a significant proportion of cases
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Heart Patient
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Heart Patient
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Heart Patient
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Heart Patient
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