fractional flow reserve (FFR)
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Introduction
A procedure to determine the ratio between the maximum achievable blood flow in a stenosed coronary artery & the theoretical maximum flow in a normal coronary artery
an FFR of 1.0 is widely accepted as normal
Indications
- coronary artery disease
- guidance for PCI in patients with multivessel disease*[3]
- improves predictions of adverse cardiac events in patients with angina pectoris from models based only on clinical variables, calcium score, & stenoses identified by coronary CT angiography[6]
* revascularization on non-infarct-related arteries after STEMI determined by fractional flow reserve associated with diminished need for revascularization (6.1% vs 17.5%) but not all-cause mortality (1.4% vs 1.7%)[4]
Procedure
- HeartFlow FFR-CT software[1] can non-invasively provide an estimate of FFR using data from a coronary CT angiography
- CT scan data is sent to HeartFlow, Inc. where a case analyst creates 3D computer models of different sections of the heart & runs a blood flow simulator program on the models
- after analyzing the data & the models, the case analyst electronically sends a report with the estimated FFR values displayed as color images of the heart
Management
- stenoses with FFR >0.80: no benefit from revascularization[5]
- stenoses with FFR <0.80: benefit from PCI[5]
- risk continuum for FFR over entire range of stenosis severity
More general terms
Additional terms
Components
References
- ↑ 1.0 1.1 FDA News Release. November 26, 2014 FDA allows marketing of non-invasive device to help evaluate heart blood flow http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm424945.htm
- ↑ FDA Drug Safety Communication: November 25, 2014 FDA warns about case of rare brain infection PML with MS drug Tecfidera (dimethyl fumarate). http://www.fda.gov/Drugs/DrugSafety/ucm424625.htm
- ↑ 3.0 3.1 van Nunen LX, Zimmermann FM, Tonino PA et al Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet. August 30, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26333474 <Internet> http://thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2900057-4/abstract
- ↑ 4.0 4.1 Smits PC, Abdel-Wahab M, Neumann FJ et al for the Compare- Acute Investigators. Fractional flow reserve-guided multivessel angioplasty in myocardial infarction. N Engl J Med 2017 Mar 18; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28317428 Free full text <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1701067
Kober L. Complete revascularization in ST-elevation myocardial infarction? N Engl J Med 2017 Mar 18; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28317460 Free Article <Internet> http://www.nejm.org/doi/10.1056/NEJMe1702825 - ↑ 5.0 5.1 5.2 De Bruyne B, Fournier S, Barbato E. Real-Life Fractional Flow Reserve Circulation. 2017;135(23):2252-2254 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28584029 from Medscape http://www.medscape.com/viewarticle/884252
- ↑ 6.0 6.1 Madsen KT et al. Prognostic value of coronary CT angiography-derived fractional flow reserve on 3-year outcomes in patients with stable angina. Radiology 2023 Sep; 308:e230524. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37698477 https://pubs.rsna.org/doi/10.1148/radiol.230524