Fractional Flow Reserve–Guided Revascularization

Petraco, Ricardo; Sen, Sayan; Nijjer, Sukhjinder; Echavarría‐Pinto, Mauro; Escaned, Javier; Francis, Dárrel P.; Davies, Justin E.

doi:10.1016/j.jcin.2012.10.014

Cited by 142 publications

(40 citation statements)

References 15 publications

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“…iFR remains a novel technology that offers an alternative to stenosis assessment using hyperemia. Classification match with fractional flow reserve, a hyperemic pressure-only index, is good but is not expected to be absolute because fractional flow reserve classification itself can differ when the index is close to its binary cutoff point (10,25). Studies such as the CLARIFY (Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study) (7) and comparisons with positron emission tomography (26) have shown that it is possible in certain circumstances to reduce the iFR value with administration of vasodilator drugs.…”

Section: Future Developments: Coregistration Andmentioning

confidence: 99%

Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease

Nijjer

Sen

Petraco

et al. 2014

JACC: Cardiovascular Interventions

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Section: Future Developments: Coregistration Andmentioning

confidence: 99%

Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease

Nijjer

Sen

Petraco

et al. 2014

JACC: Cardiovascular Interventions

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120

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“…FFR reproducibility data from the DEFER study were analysed to see the effects of FFR measurement variability on FFR-guided treatment strategy. 60 This analysis showed that outside the FFR range of 0.75-0.85, classification certainty (PCI performance versus deferral) from a single FFR result is >95 %. However, closer to its cut-off value, certainty falls to <80 % within the range of 0.77-0.83; reaching a nadir of 50 % at the precisely defined cut-off point of 0.80.…”

Section: What Happens When We Dichotomise Continuous Data?mentioning

confidence: 87%

“…In clinical practice, this means that each time a single FFR value falls between the range of 0.75-0.85, there is a chance that the FFR-derived dichotomous revascularisation recommendation will change if the measurement is repeated 10 minutes later, with a 0.80 result shown to be as repeatable as a coin toss. 60 This is not a limitation of FFR; rather, this is a limitation of any measured clinical variable where so many physiological factors input into the result. The consequences for the operator, however, are obvious.…”

Section: What Happens When We Dichotomise Continuous Data?mentioning

confidence: 99%

Fractional Flow Reserve: Does a Cut-off Value add Value?

Mohdnazri

Sharp

2016

Interventional Cardiology Review

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CoronaryFractional flow reserve (FFR) is an index used to describe the physiological significance of a coronary stenosis. It measures the pressure drop under conditions of maximal hyperaemia between the aorta and a selected vessel location distal to an angiographic lesion. 1 Several FFR studies have identified patient groups in whom coronary stenting is associated with improved outcomes when compared with medical therapy (and vice versa). FFR-guided treatment prevents unnecessary stenting and therefore coronary physiology has been associated with improved outcomes at reduced cost, a rare combination in a new technology.2-7 Coronary physiological assessment is now an integral part of the modern catheterisation laboratory, with a level 1A recommendation by the European Society of Cardiology (ESC) for use in stable patients in whom evidence of ischaemia is not already available. Ischaemic Heart Disease and Coronary RevascularisationAngina is the clinical manifestation of myocardial ischaemia in patients with stable coronary artery disease (CAD). It is caused by transient imbalance between blood supply and metabolic demand. The myocardial ischemia that causes angina is, however, not simply a question of a 'blocked pipe'; rather, ischaemia is a result of complex pathophysiological mechanisms that include obstructive epicardial CAD, inflammation, microvascular coronary dysfunction, endothelial dysfunction, thrombosis and angiogenesis (see Figure 1). 10Obstructive epicardial CAD is only one of the factors that contributes to myocardial ischaemia and yet, in the treatment of ischaemic heart disease (IHD), great (some would say overwhelming) emphasis is given to identifying and eliminating obstructive epicardial CAD over other potential causes of ischaemia, some of which may have key therapeutic roles in treating patients with IHD. The reason for this emphasis is obvious -obstructive epicardial CAD is easily identified, easily understood and relatively easily treated by angiography and stenting or bypass grafting. Doing so, however, does not always relieve ischaemia. Concept and Validation of Fractional Flow ReserveWhen FFR is used to identify a potentially ischaemia-causing lesion, the aim is to identify deficient blood flow distal to a coronary lesion.However, unlike coronary pressure, measurement of coronary blood flow in the catheter laboratory is not technically straightforward. positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI. KeywordsCoronary physiology, fractional flow reserve, pressure wire Disclosure: SRM and TRK have received rese...

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“…35 To increase to close to 100% the sensitivity to detect ischemia, a FFR cut-off value of 0.80 has been recently used. 12 In a recent study, Petraco et al 36 suggested that the gray zone for the FFR measurement is between 0.75 and 0.85. In clinical practice, this means that each time a single FFR measurement falls between 0.75 and 0.85, there is a chance that a recommendation for revascularization guided by FFR may change if the measurement is repeated after 10 minutes; the chance becomes greater as the FFR result becomes closer to 0.80.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve

Costantini¹,

Ramires

Costantini³

et al. 2016

Arquivos Brasileiros De Cardiologia

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BackgroundFunctional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR) has become the most widely used.ObjectiveTo evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction.MethodsRetrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or ≥ 70% in other segments) estimated by quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS). All cases presented ischemia in one of the noninvasive studies.ResultsAll 96 patients presented ischemia (100%) in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values ≤ 0.80. On correlation analysis for FFR ≤ 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed.ConclusionCoronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.

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Fractional Flow Reserve–Guided Revascularization

Cited by 142 publications

References 15 publications

Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease

Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease

Fractional Flow Reserve: Does a Cut-off Value add Value?

Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve

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