Fractional Flow Reserve Derived from a Single Angiographic View: Fact or Fiction?

Area of Science:

• Cardiology
• Medical Imaging
• Computational Fluid Dynamics

Background:

• Accurate assessment of coronary artery stenosis is vital for guiding revascularization in coronary artery disease (CAD).
• Invasive wire-based fractional flow reserve (FFR) is the gold standard but faces limitations in routine clinical adoption due to complexity and cost.
• Development of non-invasive, angiography-derived FFR techniques is crucial for broader application.

Purpose of the Study:

• To review the principles, validation, and clinical utility of single-view angiography-derived FFR technologies.
• To highlight the potential of these methods to increase the adoption of physiology-guided coronary interventions.
• To compare the performance of various single-view FFR techniques, particularly µQFR.

Main Methods:

• Review of existing literature on single-view angiography-derived FFR techniques.
• Analysis of validation data comparing non-invasive methods with invasive FFR.
• Discussion of computational modeling, AI, and image processing in FFR estimation from coronary angiography.
• Focus on methods like Murray law-based quantitative flow ratio (µQFR), FFR2D, Angio-iFR/FFR, sAccuFFR, and X1-FFR.

Main Results:

• Single-view angiography-derived FFR methods simplify physiological evaluation without pressure wires or hyperaemia.
• µQFR shows consistent validation against invasive FFR across diverse clinical scenarios, including complex lesions and acute coronary syndromes.
• These techniques aim to maintain diagnostic accuracy while streamlining the workflow for coronary interventions.

Conclusions:

• Single-view angiography-derived FFR technologies offer a promising, less invasive alternative to traditional invasive FFR.
• µQFR demonstrates robust performance and broad applicability in assessing coronary stenosis significance.
• Wider adoption of these simplified physiological assessment tools can enhance the management of patients with coronary artery disease.