Invasive fractional flow reserve: Which technology is best?

Area of Science:

• Cardiovascular diagnostics
• Interventional cardiology
• Physiological assessment of coronary stenosis

Background:

• Invasive pressure measurements like hyperemic fractional flow reserve (FFR) and nonhyperemic pressure measurements (NHPR) offer superior assessment of 50-90% coronary stenoses compared to angiography alone.
• FFR devices utilizing piezoelectric and optical sensors demonstrate high concordance (94%) in measured values.
• Microcatheter-based FFR systems exhibit higher rates of lesion-crossing failure and reduced pressure drift than guidewire-based systems.

Discussion:

• While FFR and NHPR show comparable statistical performance, clinical preference may lean towards NHPR.
• NHPR avoids potential side effects associated with adenosine-induced hyperemia.
• NHPR circumvents issues related to variable vasodilator responses and limitations in specific patient populations.

Key Insights:

• Both FFR and NHPR are effective tools for evaluating intermediate coronary lesions.
• Technological variations in FFR devices (sensor type, catheter design) impact usability and performance.
• Patient-specific factors and the avoidance of hyperemia are key considerations in selecting between FFR and NHPR.

Outlook:

• Further research may refine NHPR techniques and expand their clinical applicability.
• Optimizing microcatheter designs could mitigate lesion-crossing challenges in FFR assessment.
• Personalized approaches to coronary stenosis evaluation will likely integrate both FFR and NHPR data.