Fractional Flow Reserve (FFR)


FFR modality

Fractional flow reserve measurement

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Use FFR to help determine the culprit lesion.

What is FFR?

What is the FFR modality
Fractional Flow Reserve (FFR) measurement involves determining the ratio between the maximum achievable blood flow in the presence of stenosis compared to the theoretical maximum flow in a normal coronary artery with a hypothetical absence of the stenosis.

Fractional Flow Reserve measurement

FFR is easily measured during routine coronary angiography by using a pressure wire to calculate the ratio between coronary pressure distal to a coronary artery stenosis and aortic pressure under conditions of maximum myocardial hyperemia.This ratio represents the potential decrease in coronary flow distal to the coronary stenosis.
Various clinical studies demonstrate that physiologic lesion assessment by FFR to guide routine PCI is superior to current angiography guided treatment.5
FFR standard
  • Identify appropriate culprit lesion(s) in multi-vessel coronary artery disease (CAD)
  • Clinically proven for ischemia detection 3, 6
  • Supported by guidelines worldwide 3, 7
  • Determine the physiologic and hemodynamic significance of an stenosis 2
  • Measure the functional importance of a stenosis in the presence of distal collateral flow 2
  • Identify the precise location of a coronary lesion when the angiographic image is unclear 2

FFR ischemia scale


An FFR lower than 0.75-0.80 is generally considered to be associated with myocardial ischemia.3

  • FFR < 0.75 was validated against the 3 gold standard tests to correlate with ischemia with 100% specificity
  • FFR between 0.75 and 0.80 may indicate ischemia
  • FFR > 0.80 is highly likely to be non‑ischemic
  • AUC guidelines reflect the FAME cutoff of 0.80

FAME I


FFR-guided procedures improved outcomes over angio-guided procedures at 1-year outcomes.3

FAME I study results

Relative risk reduction

  • The FFR group performed significantly better in MACE-free survival 30 – 360 days
  • The FFR group was statistically significant in Death/MI and MACE but improved in all metrics vs. the angio-guided group

FAME II


FAME II demonstrated that FFR-guided PCI resulted in significantly improved clinical outcomes at 1 year, compared to medical therapy alone.4

FAME II study results
  • FAME II randomized patients with FFR < 0.8 to PCI + MT or MT compared to patients with FFR > 0.8 who received MT
  • 83% relative risk reduction in urgent revascularization in FFR PCI + MT group

The Verrata pressure guide wire

One wire, one system, multi-modality

 

  • Compatible with Philips Image Guided Therapy consoles
  • iFR and FFR modalities are on adjacent tabs in an upgraded Philips console
  • Switch back and forth between modalities easily, and effortlessly
The Verrata pressure guide wire
  1. 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 Jun 27. 334(26):1703-8. [Medline].
  2. http://emedicine.medscape.com/article/1839601-overview#a4
  3. Pijls NH, Fearon WF, Tonino PA, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol. 2010;56(3):177-84
  4. 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(11):991-1001.
  5. Physiologic Assessment of Coronary Artery Disease: Focus on Fractional Flow Reserve. Korean J Radiol. 2016 May-Jun; 17(3): 307–320.
  6. Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis.  Br J Radiol. November 2014; 87(1043): 20140159.
  7. https://www.usa.philips.com/healthcare/education-resources/technologies/igt/instant-wave-free-ratio