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Published on: June 28, 2019
A Practical Guide for Fractional Flow Reserve Guided Revascularisation
Abdul Rahman Ihdayhid1, Andy Yong2, Richard Harper1
1Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia.
Insights
Fractional Flow Reserve (FFR) assesses myocardial ischaemia, guiding revascularisation for stable coronary artery disease. FFR-guided treatment improves outcomes and lowers costs compared to angiography alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Physiology
Background:
- Myocardial ischaemia significantly impacts prognosis and revascularisation benefit in stable coronary artery disease.
- Fractional Flow Reserve (FFR) is the established reference standard for invasive ischaemia assessment.
- FFR identifies lesion-specific ischaemia, applicable across diverse patient and lesion types.
Purpose of the Study:
- To review the fundamental principles of FFR.
- To provide practical guidance for FFR-guided revascularisation.
- To discuss the emerging role of non-hyperaemic indices in ischaemia assessment.
Main Methods:
- Review of existing literature and clinical guidelines on FFR.
- Analysis of FFR's diagnostic capabilities and clinical utility.
- Exploration of non-hyperaemic indices as potential alternatives or adjuncts to FFR.
Main Results:
- FFR-guided revascularisation demonstrates improved clinical outcomes.
- FFR-guided interventions lead to reduced healthcare costs compared to angiography alone.
- Emerging non-hyperaemic indices show promise in assessing ischaemia.
Conclusions:
- FFR is a crucial tool for guiding revascularisation in stable coronary artery disease.
- FFR-guided strategies offer both clinical and economic advantages.
- Further research into non-hyperaemic indices is warranted.
Abstract:
The presence and extent of myocardial ischaemia is a major determinant of prognosis and benefit from revascularisation in patients with stable coronary artery disease. Fractional Flow Reserve (FFR) is accepted as the reference standard for invasive assessment of ischaemia. Its ability to detect lesion specific ischaemia makes it a useful test in a wide range of patient and lesion subsets, with FFR guided intervention improving clinical outcomes and reducing health care costs compared to assessment with coronary angiography alone. This article will review the basic principles in FFR, practical tips in FFR guided revascularisation and the role of emerging non-hyperaemic indices of ischaemia.
