Fractional flow reserve: Difference between revisions

Latest revision as of 02:56, 9 March 2025

Fractional Flow Reserve (FFR) is a technique used in cardiology to measure the pressure differences across a coronary artery stenosis to assess the likelihood that the stenosis impedes oxygen delivery to the heart muscle. It is a valuable tool in the diagnosis and management of coronary artery disease.

Definition[edit]

Fractional Flow Reserve is defined as the ratio of the maximum achievable blood flow in a diseased coronary artery to the maximum achievable blood flow in a normal coronary artery. It is calculated during coronary catheterization using a specialized pressure wire.

Procedure[edit]

The FFR procedure involves the insertion of a pressure wire into the coronary artery during angiography. The wire measures the pressure before and after a stenosis. The patient is often administered a vasodilator such as adenosine to induce maximal blood flow, allowing for accurate measurement of the pressure gradient across the stenosis.

Clinical Significance[edit]

FFR is used to determine the functional significance of coronary artery stenoses. An FFR value of 0.80 or less is generally considered indicative of a hemodynamically significant stenosis, which may benefit from percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Advantages[edit]

FFR provides a more accurate assessment of the need for revascularization compared to angiography alone. It helps in avoiding unnecessary procedures and in optimizing patient outcomes by targeting interventions to lesions that are truly flow-limiting.

Limitations[edit]

While FFR is a powerful tool, it is not without limitations. It requires the use of adenosine, which can have side effects, and the procedure itself is invasive. Additionally, FFR measurements can be affected by technical factors such as wire drift and pressure damping.

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-'''Fractional Flow Reserve''' ('''FFR''') is a diagnostic technique used in [[cardiology]] to measure the pressure differences across a [[coronary artery]] stenosis (narrowing) to assess the likelihood that the stenosis impedes oxygen delivery to the heart muscle (myocardial ischemia). This technique is instrumental in guiding decisions on the need for [[angioplasty]] or [[stenting]] in patients with coronary artery disease (CAD).
+'''Fractional Flow Reserve''' ('''FFR''') is a technique used in [[cardiology]] to measure the pressure differences across a [[coronary artery]] stenosis to assess the likelihood that the stenosis impedes oxygen delivery to the heart muscle. It is a valuable tool in the diagnosis and management of [[coronary artery disease]].
-==Overview==
+== Definition ==
-Fractional Flow Reserve is calculated during a [[cardiac catheterization]] procedure by measuring the blood pressure before and after a coronary artery stenosis using a specialized pressure wire. The FFR value is the ratio of the maximum achievable blood flow in a diseased coronary artery to the maximum achievable flow in a hypothetical normal coronary artery. An FFR of 1.0 is considered normal, indicating that the coronary artery can deliver blood as well as a normal artery would. An FFR of 0.80 or less is typically considered indicative of myocardial ischemia, suggesting that the stenosis may warrant revascularization.
-==Procedure==
+Fractional Flow Reserve is defined as the ratio of the maximum achievable blood flow in a diseased coronary artery to the maximum achievable blood flow in a normal coronary artery. It is calculated during [[coronary catheterization]] using a specialized pressure wire.
-The FFR measurement is performed in the catheterization laboratory. The procedure involves threading a guide catheter into the coronary artery. A pressure wire is then advanced through the catheter and placed beyond the stenosis. Blood pressure is measured both before and after the stenosis while the patient is given a medication to induce [[hyperemia]] (increased blood flow), ensuring that the measurement reflects the coronary artery's capacity to deliver blood under conditions of high demand. The FFR is calculated by dividing the pressure downstream of the stenosis by the pressure upstream.
-==Clinical Significance==
+== Procedure ==
-FFR-guided percutaneous coronary intervention (PCI) has been shown to improve patient outcomes compared to traditional angiography alone. By accurately identifying which lesions are responsible for ischemia, FFR allows for more targeted and appropriate use of interventions like stenting, potentially reducing the risk of unnecessary procedures and improving clinical outcomes.
-==Advantages==
+The FFR procedure involves the insertion of a pressure wire into the coronary artery during [[angiography]]. The wire measures the pressure before and after a stenosis. The patient is often administered a [[vasodilator]] such as [[adenosine]] to induce maximal blood flow, allowing for accurate measurement of the pressure gradient across the stenosis.
-* '''Accuracy:''' FFR provides a more precise assessment of the physiological impact of a coronary artery stenosis than angiography.
-* '''Outcome Improvement:''' Studies have shown that FFR-guided PCI can lead to better patient outcomes, including reduced rates of death, myocardial infarction, and the need for urgent revascularization.
-* '''Cost-Effectiveness:''' By avoiding unnecessary stenting, FFR-guided treatment strategies can be more cost-effective for managing patients with CAD.
-==Limitations==
+== Clinical Significance ==
-* '''Invasive Procedure:''' FFR measurement requires cardiac catheterization, an invasive procedure that carries inherent risks, though they are relatively low.
-* '''Hyperemic Agents:''' The need for pharmacological induction of hyperemia can introduce variability in the measurement and may not be suitable for all patients.
-* '''Interpretation:''' The interpretation of FFR values can be influenced by various factors, including the presence of microvascular disease or the accuracy of the pressure measurements.
-==Conclusion==
+FFR is used to determine the functional significance of coronary artery stenoses. An FFR value of 0.80 or less is generally considered indicative of a hemodynamically significant stenosis, which may benefit from [[percutaneous coronary intervention]] (PCI) or [[coronary artery bypass grafting]] (CABG).
-Fractional Flow Reserve has emerged as a critical tool in the management of coronary artery disease, enabling more precise and personalized treatment decisions. By focusing interventions on lesions that genuinely impair myocardial perfusion, FFR-guided strategies can improve patient outcomes and offer a more efficient use of healthcare resources.
+== Advantages ==
+FFR provides a more accurate assessment of the need for revascularization compared to angiography alone. It helps in avoiding unnecessary procedures and in optimizing patient outcomes by targeting interventions to lesions that are truly flow-limiting.
+== Limitations ==
+While FFR is a powerful tool, it is not without limitations. It requires the use of adenosine, which can have side effects, and the procedure itself is invasive. Additionally, FFR measurements can be affected by technical factors such as wire drift and pressure damping.
+== Related pages ==
+* [[Coronary artery disease]]
+* [[Percutaneous coronary intervention]]
+* [[Coronary artery bypass surgery]]
+* [[Angiography]]
+== See also ==
+* [[Intravascular ultrasound]]
+* [[Optical coherence tomography]]
 [[Category:Cardiology]]
-[[Category:Medical tests]]
+[[Category:Medical procedures]]
-[[Category:Coronary artery disease]]
-{{Cardiology-stub}}