Performing and Interpreting Fractional Flow Reserve Measurements in Clinical Practice: An Expert Consensus Document
Stephan Achenbach1, Tanja Rudolph2, Johannes Rieber3
1Department of Cardiology, Friedrich-Alexander University (FAU) Erlangen-Nuremberg, Germany.
Insights
Fractional flow reserve (FFR) measurements assess coronary artery blockages. Deferring revascularization is safe if FFR > 0.80, while FFR ≤ 0.80 improves outcomes with treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Fractional flow reserve (FFR) is crucial for assessing coronary artery stenosis haemodynamic significance.
- Guidelines suggest FFR use when non-invasive ischemia proof is absent.
- FFR's prognostic impact is established in randomized trials.
Purpose of the Study:
- To summarize clinical evidence supporting FFR measurements.
- To provide practical recommendations for FFR procedure performance and interpretation.
- To address barriers hindering widespread clinical adoption of FFR.
Main Methods:
- Review of randomized trials evaluating the prognostic impact of FFR.
- Analysis of clinical data supporting the use of FFR.
- Synthesis of recommendations for FFR procedure and interpretation.
Main Results:
- Revascularization can be safely deferred in lesions with FFR > 0.80.
- Revascularization of stenoses with FFR ≤ 0.80 significantly reduces event rates compared to medical treatment.
- Exclusion of specific patient groups (e.g., left main, severe LVH) from major trials exists.
Conclusions:
- FFR is a valuable tool for guiding revascularization decisions in coronary artery disease.
- Addressing procedural and interpretational uncertainties can improve FFR's clinical utility.
- Standardized recommendations can enhance the consistent application of FFR in practice.
Abstract:
Fractional flow reserve (FFR) measurements can determine the haemodynamic relevance of coronary artery stenoses. Current guidelines recommend their use in lesions in the absence of non-invasive proof of ischaemia. The prognostic impact of FFR has been evaluated in randomised trials, and it has been shown that revascularisation can be safely deferred if FFR is >0.80, while revascularisation of stenoses with FFR values ≤0.80 results in significantly lower event rates compared to medical treatment. Left main stenoses, aorto-ostial lesions, as well as patients with left ventricular hypertrophy and severely-impaired ejection fraction, have been excluded from large, randomised trials. While FFR measurements are relatively straightforward to perform, uncertainty about procedural logistics, as well as data acquisition and interpretation in specific situations, could explain why they are not widely used in clinical practice. We summarise the clinical data in support of FFR measurements, and provide recommendations for performing and interpreting the procedure.
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