Related Experiment Video
Updated: May 3, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Fractional flow reserve-guided percutaneous coronary intervention: does coronary pressure never lie?
Tim P van de Hoef1, Martijn A van Lavieren, José P S Henriques
1AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Insights
Fractional flow reserve (FFR) offers clear benefits for coronary revascularization. However, its diagnostic characteristics and assumptions require deeper understanding for accurate clinical application and interpretation.
Area of Science:
- Cardiology
- Physiology
- Medical Diagnostics
Background:
- Fractional flow reserve (FFR)-guided coronary revascularization demonstrates significant clinical advantages over angiography alone.
- Misconceptions exist regarding FFR's diagnostic capabilities, leading to its use as a definitive test for ischemia-related stenosis.
- FFR's original validation against noninvasive stress testing is often overlooked, creating a paradox in its current application.
Purpose of the Study:
- To clarify the complex diagnostic characteristics of FFR.
- To elucidate the underlying physiological assumptions and their clinical implications.
- To highlight practical methodologies for accurate FFR interpretation.
Main Methods:
- Review of existing literature on FFR validation and application.
- Analysis of the physiological basis and assumptions of FFR.
- Discussion of empirical evidence from randomized controlled trials.
Main Results:
- FFR's conceptual validity relies on multiple assumptions not always considered in practice.
- Clinical utility of FFR is supported by robust empirical data from large trials.
- Understanding FFR's physiological underpinnings is crucial for correct interpretation.
Conclusions:
- A comprehensive understanding of FFR's physiological basis and assumptions is essential for appropriate clinical use.
- FFR interpretation requires awareness of its limitations and the context of its validation.
- This review provides insights into FFR's complexities for improved patient care.
Opinion Statement:
Fractional flow reserve (FFR)-guided coronary revascularization is associated with an unequivocal clinical benefit compared with angiographic guidance. However, the well-documented clinical merit of FFR-guided revascularization has resulted in several misunderstandings as to its diagnostic characteristics. Moreover, it has led to the use of FFR as a gold-standard reference test for the identification of stenosis-related inducible myocardial ischemia. Frequently overlooked is the fact that FFR was originally validated against noninvasive stress-testing to document its ability to identify ischemia-generating stenoses, as well as its optimal cut-off value to do so, which illustrates the paradox of using FFR as a gold-standard reference for this purpose. The diagnostic characteristics of FFR are more complex than is widely understood, and its conceptual validity is based on multiple assumptions that are not considered in clinical practice. In contrast, the validity of FFR as a clinical tool is based on empirical evidence derived from multiple large-scale randomized controlled trials. It is, therefore, of great importance to understand the fundamental physiological basis of FFR, and to be aware of the underlying assumptions and their implications, for appropriate application and interpretation of FFR on an individual basis. This review aims to elucidate the assumptions that underlie the concept of FFR, to provide insight into their consequences for daily practice, and to highlight the practical methodology that is critical for its interpretation in clinical practice.
