Invasive physiological assessment of coronary disease (FFR)

Summary

Revascularisation by percutaneous coronary intervention (PCI) with stent placement or coronary bypass surgery, should be targeted at relieving myocardial ischaemia. However, non-invasive stress testing and coronary angiography will not always provide adequate or complete information about the functional importance of coronary artery stenoses.

Introduction

The index Fractional Flow Reserve (FFR) is considered the gold standard for the detection of myocardial ischaemia, related to a particular stenosis. By using FFR in patients with coronary artery disease, the interventional cardiologist is able to accurately distinguish between coronary stenoses that induce myocardial ischaemia and those that do not. Its invasive nature is balanced by some unique and advantageous features, such as its unequalled spatial resolution and its linear relation to maximum blood flow. Moreover, FFR has an unequivocal normal value, takes into account collateral blood flow and amount of viable myocardial mass, is independent of haemodynamic variations, and has a high reproducibility. Clinical outcome data of patients in whom the revascularisation strategy has been based on FFR measurements are convincing across many different lesion subsets. Based on the available clinical evidence and the current guidelines on revascularisation, FFR evaluation is indicated for all coronary artery stenoses of 50-90%, including left main stenosis,...