Contents

Search

fractional flow reserve (FFR)

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] Procedures: - 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

Related

coronary flow reserve (CFR)

General

clinical procedure

References

  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
  2. 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. 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 PMID: 26333474 http://thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2900057-4/abstract
  4. 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; PMID: 28317428 Free full text http://www.nejm.org/doi/10.1056/NEJMoa1701067 - Kober L. Complete revascularization in ST-elevation myocardial infarction? N Engl J Med 2017 Mar 18; PMID: 28317460 Free Article http://www.nejm.org/doi/10.1056/NEJMe1702825
  5. De Bruyne B, Fournier S, Barbato E. Real-Life Fractional Flow Reserve Circulation. 2017;135(23):2252-2254 PMID: 28584029 from Medscape http://www.medscape.com/viewarticle/884252
  6. 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: 37698477 https://pubs.rsna.org/doi/10.1148/radiol.230524

Components

CT of heart