A Test in Context: Fractional Flow Reserve: Accuracy, Prognostic Implications, and Limitations

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology

Background:

• Fractional flow reserve (FFR) is an invasive diagnostic tool for assessing coronary artery stenosis severity.
• Its utility is pronounced in intermediate or ambiguous lesions where noninvasive tests are unavailable or discordant.

Purpose of the Study:

• To review the fundamental basics of FFR testing.
• To summarize the clinical evidence supporting FFR use.
• To discuss the limitations and technical factors affecting FFR accuracy.

Main Methods:

• Review of randomized clinical trials and societal guidelines.
• Analysis of technical considerations for accurate FFR measurement.

Main Results:

• FFR-guided revascularization improves clinical outcomes, reducing cardiac death/myocardial infarction and healthcare costs compared to angiography alone.
• Guidelines recommend FFR for intermediate stenoses, especially with discordant noninvasive testing.

Conclusions:

• FFR is a valuable tool for guiding coronary revascularization, supported by robust clinical evidence.
• Meticulous attention to technical factors is crucial to ensure the accuracy and reliability of FFR measurements.