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
FAQ
FFR is a special test used during coronary angiography to measure blood flow in the heart arteries. It helps doctors determine whether a blockage is severe enough to need a stent or bypass surgery.
If your angiogram shows narrowed arteries, FFR helps your doctor decide if the narrowing is actually limiting blood flow to your heart. This ensures you get the right treatment — whether it’s medication or a procedure.
During your angiogram, a thin pressure wire is inserted into the artery. A small amount of medication may be given to temporarily widen the arteries, and then blood pressure is measured across the blockage to assess its impact.
No. FFR is done while you’re already under local anesthesia and mild sedation during an angiogram. It is safe and painless, with very low risk when performed by trained cardiologists.
FFR usually takes just a few extra minutes during your angiogram. It adds little time to the procedure but provides valuable information to guide your treatment.
- An FFR value of 0.80 or less usually means the blockage is restricting blood flow and may benefit from stenting.
- A value above 0.80 often means the blockage is not serious enough to need a stent.
Only if the FFR test shows the blockage is functionally significant. If not, you may be safely treated with medications and lifestyle changes, avoiding unnecessary procedures.
Yes. While angiography shows how narrow an artery is, FFR shows how much that narrowing is actually affecting blood flow. This helps avoid both over- and under-treatment.
FFR is most useful for people with stable coronary artery disease or unclear angiogram results. Your doctor will decide if FFR is appropriate based on your condition.
No special preparation is needed beyond what’s required for a routine angiogram. Your care team will guide you on fasting, medications, and recovery instructions.
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