Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation

• Published in: European heart journal Vol. 41; no. 34; pp. 3271 - 3279
• Main Authors: Tu, Shengxian, Westra, Jelmer, Adjedj, Julien, Ding, Daixin, Liang, Fuyou, Xu, Bo, Holm, Niels Ramsing, Reiber, Johan H C, Wijns, William
• Format: Journal Article
• Language: English
• Published: England 07-09-2020
• Subjects: Cardiac Catheterization; Coronary Angiography; Coronary Stenosis - diagnosis; Coronary Vessels - diagnostic imaging; Fractional Flow Reserve, Myocardial; Humans; Predictive Value of Tests; Severity of Illness Index; Myocardial ischaemia; IVUS; Coronary artery disease; Fractional flow reserve; OCT and coronary angiogram
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz918

Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance of epicardial coronary stenosis. Despite the overall trend towards more physiology-guided revascularization, there remains a gap between guideline recommendations and the clinical adoption of functional evaluation of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologies, we sought to highlight the principles, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization laboratory. Computational FFR has the potential to expand and facilitate the use of physiology for diagnosis, procedural guidance, and evaluation of therapies, with anticipated impact on resource utilization and patient outcomes.