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The Evolving Future of Instantaneous Wave-Free Ratio and Fractional Flow Reserve

Matthias Götberg1, Christopher M Cook2, Sayan Sen2

  • 1Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.

Journal of the American College of Cardiology
|September 9, 2017
PubMed

Insights

Coronary physiology using iFR and FFR is crucial for managing coronary artery disease. Future applications will guide revascularization decisions beyond stable angina.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Diagnostic Technologies

Background:

  • Coronary artery disease (CAD) management relies on accurate stenosis assessment.
  • Physiological indices like instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) are key tools.
  • Understanding their evolution is vital for current and future clinical practice.

Purpose of the Study:

  • To review the scientific basis and clinical validation of iFR and FFR.
  • To explore the future trajectory of physiological stenosis assessment.
  • To discuss the potential of iFR in guiding revascularization decisions.

Main Methods:

  • Critical appraisal of experimental and validation studies for iFR and FFR.
  • Review of clinical trials assessing the outcomes associated with iFR and FFR use.
  • Analysis of current literature and expert opinion on future developments.

Main Results:

  • iFR and FFR have evolved from theoretical concepts to clinically validated tools.
  • Evidence supports their use in assessing ischemia and guiding management in stable angina.
  • Emerging data suggests broader applications in complex coronary lesions and beyond stable disease.

Conclusions:

  • Physiological assessment with iFR and FFR is integral to modern CAD management.
  • Future developments will expand their role from justifying to actively guiding revascularization.
  • Continued research will refine their application in diverse clinical scenarios.

Keywords:
coronary artery bypass graftcoronary physiologycoronary stenosismyocardial revascularizationpercutaneous coronary intervention

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