Revision as of 14:23, 21 February 2025

Fractional Flow Reserve

Diagram illustrating the concept of fractional flow reserve.

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

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

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.

File:Image-Image-ffr4.jpg

Pressure wire used in FFR measurement.

Clinical Significance

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

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.

File:Ffr5.jpg

Graph showing FFR values and corresponding clinical decisions.

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-{{Short description|A guide to understanding Fractional Flow Reserve in cardiology}}
+= Fractional Flow Reserve =
-==Fractional Flow Reserve==
+[[File:Image-ffr3.jpg|thumb|right|Diagram illustrating the concept of fractional flow reserve.]]
-[[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==
+'''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]].
-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==
+== Definition ==
-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)
+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.
-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).
+== Procedure ==
-==Clinical Significance==
+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.
-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==
+[[File:Image-Image-ffr4.jpg|thumb|left|Pressure wire used in FFR measurement.]]
-* 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==
+== Clinical Significance ==
-* Requires the use of pharmacological agents to induce hyperemia.
-* Invasive procedure with associated risks.
+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).
-* May not be applicable in certain anatomical situations, such as severe tortuosity or calcification.
+== 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.
+[[File:Ffr5.jpg|thumb|right|Graph showing FFR values and corresponding clinical decisions.]]
+== Related pages ==
-==Related pages==
 * [[Coronary artery disease]]
 * [[Percutaneous coronary intervention]]
-* [[Coronary angiography]]
+* [[Coronary artery bypass surgery]]
-* [[Adenosine]]
+* [[Angiography]]
+== See also ==
+* [[Intravascular ultrasound]]
+* [[Optical coherence tomography]]
 [[Category:Cardiology]]
+[[Category:Medical procedures]]

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