Skip to main content
SpringerLink
Log in

Fractional Flow Reserve

  • Chapter
  • First Online:
Cardiac Surgery

  • 268 Accesses

Abstract

Since its introduction in 1994 fractional flow reserve (FFR) has revolutionized the way cardiologists and cardiac surgeons view myocardial revascularization. The FFR is currently considered the gold standard for assessment of functional significance of coronary stenosis and the expected benefit from revascularization. It has changed the focus from treating angiographically significant lesions to haemodynamically significant stenoses and has been established as one of the most important tools guiding revascularization. The FFR provides a well-defined cut-off value for deciding whether to revascularize immediately or to defer intervention. This chapter focuses on the definition of FFR, its applications, limitations and outcome studies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol. 2010;55:173–85.

    Article  Google Scholar 

  2. White CW, Wright CB, Doty DB, et al. Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med. 1984;310:819–24.

    Article  CAS  Google Scholar 

  3. Beauman GJ, Vogel RA. Accuracy of individual and panel visual interpretations of coronary arteriograms: implications for clinical decisions. J Am Coll Cardiol. 1990;16:108–13.

    Article  CAS  Google Scholar 

  4. Qian J, Ge J, Baumgart D, et al. Safety of intracoronary Doppler flow measurement. Am Heart J. 2000;140:502–10.

    Article  CAS  Google Scholar 

  5. Donohue TJ, Kern MJ, Aguirre FV, et al. Assessing the hemodynamic significance of coronary artery stenoses: analysis of translesional pressure-flow velocity relations in patients. J Am Coll Cardiol. 1993;22:449–58.

    Article  CAS  Google Scholar 

  6. Gould KL, Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol. 1974;34:48–55.

    Article  CAS  Google Scholar 

  7. Pijls NH, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996;334:1703–8.

    Article  CAS  Google Scholar 

  8. Pijls NH, Van Gelder B, Van der Voort P, et al. Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation. 1995;92:3183–93.

    Article  CAS  Google Scholar 

  9. Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24.

    Article  CAS  Google Scholar 

  10. De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991–1001.

    Article  Google Scholar 

  11. Adjedj J, De Bruyne B, Flore V, et al. Significance of intermediate values of fractional flow reserve in patients with coronary artery disease. Circulation. 2016;133:502–8.

    Article  CAS  Google Scholar 

  12. Panoulas VF, Keramida K, Boletti O, et al. Association between fractional flow reserve, instantaneous wave-free ratio and dobutamine stress echocardiography in patients with stable coronary artery disease. EuroIntervention. 2018;13:1959–66.

    Article  Google Scholar 

  13. Watkins S, McGeoch R, Lyne J, et al. Validation of magnetic resonance myocardial perfusion imaging with fractional flow reserve for the detection of significant coronary heart disease. Circulation. 2009;120:2207–13.

    Article  Google Scholar 

  14. Lockie T, Ishida M, Perera D, et al. High-resolution magnetic resonance myocardial perfusion imaging at 3.0-Tesla to detect hemodynamically significant coronary stenoses as determined by fractional flow reserve. J Am Coll Cardiol. 2011;57:70–5.

    Article  Google Scholar 

  15. Chamuleau SA, Meuwissen M, van Eck-Smit BL, et al. Fractional flow reserve, absolute and relative coronary blood flow velocity reserve in relation to the results of technetium-99m sestamibi single-photon emission computed tomography in patients with two-vessel coronary artery disease. J Am Coll Cardiol. 2001;37:1316–22.

    Article  CAS  Google Scholar 

  16. Melikian N, De Bondt P, Tonino P, et al. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv. 2010;3:307–14.

    Article  Google Scholar 

  17. Ko BS, Cameron JD, Meredith IT, et al. Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J. 2012;33:67–77.

    Article  Google Scholar 

  18. Echavarria-Pinto M, Escaned J, Macias E, et al. Disturbed coronary hemodynamics in vessels with intermediate stenoses evaluated with fractional flow reserve: a combined analysis of epicardial and microcirculatory involvement in ischemic heart disease. Circulation. 2013;128:2557–66.

    Article  Google Scholar 

  19. Waksman R, Legutko J, Singh J, et al. FIRST: fractional flow reserve and intravascular ultrasound relationship study. J Am Coll Cardiol. 2013;61:917–23.

    Article  Google Scholar 

  20. Hamilos M, Muller O, Cuisset T, et al. Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation. 2009;120:1505–12.

    Article  Google Scholar 

  21. Fearon WF, Yong AS, Lenders G, et al. The impact of downstream coronary stenosis on fractional flow reserve assessment of intermediate left main coronary artery disease: human validation. JACC Cardiovasc Interv. 2015;8:398–403.

    Article  Google Scholar 

  22. Toth G, De Bruyne B, Casselman F, et al. Fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery. Circulation. 2013;128:1405–11.

    Article  Google Scholar 

  23. Botman CJ, Schonberger J, Koolen S, et al. Does stenosis severity of native vessels influence bypass graft patency? A prospective fractional flow reserve-guided study. Ann Thorac Surg. 2007;83:2093–7.

    Article  Google Scholar 

  24. Zimmermann FM, Ferrara A, Johnson NP, et al. Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial. Eur Heart J. 2015;36:3182–8.

    Article  Google Scholar 

  25. 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. 2015;386:1853–60.

    Article  Google Scholar 

  26. Xaplanteris P, Fournier S, Pijls NHJ, et al. Five-year outcomes with PCI guided by fractional flow reserve. N Engl J Med. 2018;379:250–9.

    Article  Google Scholar 

  27. Smits PC, Boxma-de Klerk BM. Fractional flow reserve-guided multivessel angioplasty in myocardial infarction. N Engl J Med. 2017;377:397–8.

    PubMed  Google Scholar 

  28. Sen S, Escaned J, Malik IS, et al. Development and validation of a new adenosine-independent index of stenosis severity from coronary wave-intensity analysis: results of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) study. J Am Coll Cardiol. 2012;59:1392–402.

    Article  CAS  Google Scholar 

  29. Escaned J, Echavarria-Pinto M, Garcia-Garcia HM, et al. Prospective assessment of the diagnostic accuracy of instantaneous wave-free ratio to assess coronary stenosis relevance: results of ADVISE II international, multicenter study (ADenosine vasodilator independent stenosis evaluation II). JACC Cardiovasc Interv. 2015;8:824–33.

    Article  Google Scholar 

  30. Gotberg M, Christiansen EH, Gudmundsdottir IJ, et al. Instantaneous wave-free ratio versus fractional flow reserve to guide PCI. N Engl J Med. 2017;376:1813–23.

    Article  Google Scholar 

  31. Davies JE, Sen S, Dehbi HM, et al. Use of the instantaneous wave-free ratio or fractional flow reserve in PCI. N Engl J Med. 2017;376:1824–34.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK

    Vasileios F. Panoulas

  2. National Heart and Lung Institute, Imperial College London, London, UK

    Vasileios F. Panoulas

Authors
  1. Vasileios F. Panoulas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vasileios F. Panoulas .

Editor information

Editors and Affiliations

  1. Harefield Hospital, Royal Brompton & Harefield NHS Trust, London, UK

    Shahzad G. Raja

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Panoulas, V.F. (2020). Fractional Flow Reserve. In: Raja, S. (eds) Cardiac Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-24174-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-24174-2_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24173-5

  • Online ISBN: 978-3-030-24174-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation