Fractional flow reserve: Difference between revisions

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A guide to understanding Fractional Flow Reserve in cardiology

Fractional Flow Reserve

Coronary angiogram showing a stenosis in the left anterior descending artery.

Fractional Flow Reserve (FFR) is a diagnostic technique used in cardiology to assess the physiological impact of a coronary artery stenosis. It is a measure of the pressure differences across a coronary artery stenosis to determine the likelihood of the stenosis impeding oxygen delivery to the heart muscle.

Principle

FFR is based on the principle that the severity of a coronary artery stenosis can be quantified by measuring the pressure drop across the stenosis during maximal blood flow, which is induced pharmacologically. The FFR value is calculated as the ratio of the maximum achievable blood flow in a diseased coronary artery to the theoretical maximum flow in a normal coronary artery.

Procedure

The procedure involves the insertion of a specialized pressure wire into the coronary artery during coronary angiography. A vasodilator, such as adenosine, is administered to induce maximal hyperemia. The pressure distal to the stenosis is measured and compared to the aortic pressure. The FFR is calculated using the formula:

FFR = (Distal coronary pressure) / (Aortic pressure)

An FFR value of 0.80 or less is generally considered indicative of a hemodynamically significant stenosis, warranting intervention such as percutaneous coronary intervention (PCI).

Clinical Significance

FFR is a valuable tool in the management of patients with coronary artery disease (CAD). It helps in decision-making regarding the need for revascularization procedures. Studies have shown that FFR-guided PCI improves patient outcomes compared to angiography-guided PCI alone.

Advantages

Provides a functional assessment of coronary stenosis.
Reduces unnecessary stenting by identifying lesions that do not require intervention.
Improves patient outcomes by guiding appropriate treatment.

Limitations

Requires the use of pharmacological agents to induce hyperemia.
Invasive procedure with associated risks.
May not be applicable in certain anatomical situations, such as severe tortuosity or calcification.

Related pages

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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).
+{{Short description|A guide to understanding Fractional Flow Reserve in cardiology}}
-==Overview==
+==Fractional Flow Reserve==
-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.
+[[File:Coronary_artery_angiogram.jpg|thumb|right|Coronary angiogram showing a stenosis in the left anterior descending artery.]]
+'''Fractional Flow Reserve''' ('''FFR''') is a diagnostic technique used in [[cardiology]] to assess the physiological impact of a coronary artery stenosis. It is a measure of the pressure differences across a coronary artery stenosis to determine the likelihood of the stenosis impeding oxygen delivery to the heart muscle.
+==Principle==
+FFR is based on the principle that the severity of a coronary artery stenosis can be quantified by measuring the pressure drop across the stenosis during maximal blood flow, which is induced pharmacologically. The FFR value is calculated as the ratio of the maximum achievable blood flow in a diseased coronary artery to the theoretical maximum flow in a normal coronary artery.
 ==Procedure==
-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.
+The procedure involves the insertion of a specialized pressure wire into the coronary artery during [[coronary angiography]]. A vasodilator, such as [[adenosine]], is administered to induce maximal hyperemia. The pressure distal to the stenosis is measured and compared to the aortic pressure. The FFR is calculated using the formula:
+: FFR = (Distal coronary pressure) / (Aortic pressure)
+An FFR value of 0.80 or less is generally considered indicative of a hemodynamically significant stenosis, warranting intervention such as [[percutaneous coronary intervention]] (PCI).
 ==Clinical Significance==
-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.
+FFR is a valuable tool in the management of patients with [[coronary artery disease]] (CAD). It helps in decision-making regarding the need for revascularization procedures. Studies have shown that FFR-guided PCI improves patient outcomes compared to angiography-guided PCI alone.
 ==Advantages==
-* '''Accuracy:''' FFR provides a more precise assessment of the physiological impact of a coronary artery stenosis than angiography.
+* Provides a functional assessment of coronary stenosis.
-* '''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.
+* Reduces unnecessary stenting by identifying lesions that do not require intervention.
-* '''Cost-Effectiveness:''' By avoiding unnecessary stenting, FFR-guided treatment strategies can be more cost-effective for managing patients with CAD.
+* Improves patient outcomes by guiding appropriate treatment.
 ==Limitations==
-* '''Invasive Procedure:''' FFR measurement requires cardiac catheterization, an invasive procedure that carries inherent risks, though they are relatively low.
+* Requires the use of pharmacological agents to induce hyperemia.
-* '''Hyperemic Agents:''' The need for pharmacological induction of hyperemia can introduce variability in the measurement and may not be suitable for all patients.
+* Invasive procedure with associated risks.
-* '''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.
+* May not be applicable in certain anatomical situations, such as severe tortuosity or calcification.
-==Conclusion==
+==Related pages==
-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.
+* [[Coronary artery disease]]
+* [[Percutaneous coronary intervention]]
+* [[Coronary angiography]]
+* [[Adenosine]]
 [[Category:Cardiology]]
-[[Category:Medical tests]]
-[[Category:Coronary artery disease]]
-{{Cardiology-stub}}
-<gallery>
-File:Image-ffr3.jpg|Fractional flow reserve
-File:Image-Image-ffr4.jpg|Fractional flow reserve
-File:Ffr5.jpg|Fractional flow reserve
-</gallery>