Fractional flow reserve (FFR) is the gold standard for invasive ischemia assessment, with FFR > 0.8 used to defer unnecessary procedures and an optimal post-stenting FFR > 0.9 recommended.
This review highlights the utility of FFR and non-hyperemic indices in guiding percutaneous coronary interventions for intermediate lesions.
Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact. Fractional flow reserve (FFR) received a class IA recommendation from the European Society of Cardiology for the assessment of angiographically moderate stenosis. FFR evaluation of coronary artery disease offers improvement of the therapeutic strategy, deferring unnecessary procedures for lesions with a FFR > 0.8, improving patients' management and clinical outcome. Post intervention, an optimal FFR > 0.9 post stenting should be reached and > 0.8 post drug eluting balloons. Non-hyperemic pressure ratio measurements have been validated in previous studies with a common threshold of 0.89. They might overestimate the hemodynamic significance of some lesions but remain useful whenever hyperemic agents are contraindicated. FFR remains the gold standard reference for invasive assessment of ischemia. We illustrate this review with two cases introducing the possibility to estimate also non-invasively FFR from reconstructed 3-D angiograms by quantitative flow ratio. We conclude introducing a hybrid approach to intermediate lesions (DFR 0.85-0.95) potentially maximizing clinical decision from all measurements.
Boutaleb et al. (Thu,) conducted a review in Coronary artery disease. Fractional flow reserve (FFR) and non-hyperemic indices was evaluated. Fractional flow reserve (FFR) is the gold standard for invasive ischemia assessment, with FFR > 0.8 used to defer unnecessary procedures and an optimal post-stenting FFR > 0.9 recommended.
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