Fractional Flow Reserve

Fractional Flow Reserve (FFR), a diagnostic procedure beyond angiography, is applied in patients who have undergone equivocal and intermediate lesions of single-vessel diseases for assessing hemodynamic significance. Over the last decade, FFR has been established in various anatomical and clinical subsets. To Know More

Fractional Flow Reserve (FFR) is chiefly a diagnostic procedure beyond angiography. It determines if a cardiac patient needs bypass surgery or a stent implant (angioplasty) or no procedure, just medications. This scientific and evidence-based procedure is greatly beneficial to patients as FFR saves lives, avoiding unnecessary interventions. It is also used for increasing accuracy of interventions. FFR-guided stent implantation has been seen to be economically beneficial in cost-effectiveness analysis.

One of the conditions of heart disease is blockages (plaque deposit) in arteries. When the blockages limit the amount of blood flowing through the artery, they are termed as “serious” or “haemodynamically significant”. These may cause symptoms like shortness of breath, chest discomfort and can also cause heart attacks.

Angiography, the first preferred diagnostic tool used to confirm the presence of a heart block, has limitations as it fails to identify the significance of moderately severe lesions.

How is FFR calculated?

Fractional Flow Reserve maps the ratio of the maximum achievable flow in the presence of stenosis to the theoretical maximum flow in the same vessel in its absence. It takes into consideration multiple, complex variables influencing the coronary flow, including the lesion length, lesion severity, and collateral flow.

Thus, if FFR shows that there is a noticeable difference between the two measurements, then the blockage is considered to be significant. FFR correlates well with non-invasive stress testing. The procedure is considered complementary to conventional Angiogram, when the tightness of a specific blockage is not easily depicted by Angiography or when patients have not undergone non-invasive stress testing.

Indications and patient selection

FFR was applied in patients who had undergone equivocal and intermediate lesions of single-vessel diseases for assessing hemodynamic significance. Over the last decade, FFR has been established in various anatomical and clinical subsets of the following:

• Multi-vessel disease
• Left main lesions
• Acute coronary syndrome
• Bifurcation and ostial branch stenosis
• Diffuse atherosclerosis
• Sequential stenosis
• Bypass grafts

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