Korean Circ J.  2012 Jul;42(7):441-446. 10.4070/kcj.2012.42.7.441.

Fractional Flow Reserve: The Past, Present and Future

• Kim JE
• Koo BK

• KMID: 2094114
• DOI: http://doi.org/10.4070/kcj.2012.42.7.441

Abstract

Revascularization of coronary artery stenosis should be based on the objective evidence of ischemia. It is common practice for physicians to make decisions on revascularization in the cardiac catheterization laboratory based on the results of angiography, despite the fact that angiographic information does not correlate well with the functional significance of a coronary lesion. Fractional flow reserve (FFR) is a physiologic parameter which can be measured easily during the invasive procedure and can assess the functional significance of coronary stenosis. FFR-guided revascularization strategy is reported to be more effective than angiography-guided strategy in patients with coronary artery disease. Moreover, novel technologies based on FFR have been developed and will soon be incorporated into clinical practice.

Keyword

Coronary artery disease; Fractional flow reserve, myocardiol; Ischemia

MeSH Terms

Angiography
Cardiac Catheterization
Cardiac Catheters
Coronary Artery Disease
Coronary Stenosis
Humans
Ischemia

Figure

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  Fig. 1 The concept of fractional flow reserve (FFR). : hyperemic myocardial blood flow in the presence of a stenosis, : normal hyperemic myocardial blood flow, Pd: distal coronary pressure, Pa: aortic pressure, Pv: venous pressure, R: hyperemic myocardial resistance.

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  Fig. 2 Clinical application of FFR to a patient with multiple lesions and multi-vessel disease. By coronary angiography, 11 stenoses (arrow) were found, yet none of those in the left anterior descending and left circumflex arteries were functionally significant by FFR. FFR values measured in the right coronary artery was FFR 0.65 and pullback pressure tracing revealed the lesion at the mid right coronary artery (*) was hemodynamically the most significant stenosis. After one stent implantation at the mid right coronary artery, the FFR was 0.81. FFR: fractional flow reserve.

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  Fig. 3 Correlation between iFR and FFR according to the coronary artery (data from ADVISE study, courtesy of Justin Davies, MD). iFR: instantaneous wave-free ratio, FFR: fractional flow reserve.

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  Fig. 4 A case example of CT-derived computed FFR. By coronary CT angiography, significant stenosis was found at the proximal left anterior descending coronary artery. When this lesion was assessed by CT-derived computed FFR, FFRG was 0.74 and found to be functionally significant. This information derived from non-invasive assessment matched very well with invasive angiography and invasive FFR measurement (FFR=0.74). FFR: fractional flow reserve.

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  Fig. 5 Comparison of the diagnostic performance between FFRCT and CCTA (from DISCOVER FLOW study, per-vessel analysis, n=159). PPV: positive predictive value, NPV: negative predictive value, FFRCT: CT-derived computed FFR, CCTA: coronary CT angiography, DISCOVER FLOW: Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve, FFR: fractional flow reserve.

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