This review highlights the evolving role of pressure-wire technologies like FFR and iFR in guiding interventional cardiology procedures.
May support FFR/iFR adoption for PCI decisions; extends prior syntheses but leaves open need for updated outcome trials.
Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes. We also review the instantaneous wave-free ratio (iFR), a new pressure-only index, measured at rest, that is under active evaluation in several international randomized controlled trials. We review the accumulated evidence and discuss the important physiological concepts between pressure and flow that underlie the approach to using resting indices. Finally we investigate future developments, including physiological mapping with iFR-Pullback and the potential to predict the hemodynamic effect of stenting.
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Nijjer et al. (2015) conducted a review in Coronary artery disease. Coronary physiology assessment (FFR and iFR) vs. Angiography-guided assessment was evaluated.
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