Overview
The cardiology department of Aster Hospitals enlists several advanced medical facilities, including the fractional flow reserve testing. Experienced cardiac surgeons and interventional radiologists help to diagnose severe blockages in the coronary arteries via this test.
FFR is a minimally invasive procedure to measure the stenosis (narrowing) in the coronary arteries. This procedure indicates how severe the blockage is by comparing the highest possible blood flow to the arteries without and with stenosis.
FFR is part of the test done during the coronary angiogram or coronary catheterization to plan the course of treatment for the patient.
Health Conditions Treated
Coronary artery disease
Arterial blockages
Abnormal blood clotting
FAQs
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Who performs the FFR procedure?
A cardiologist performs the FFR procedure.
What is the usual range of FFR value?
1.0 is the widely accepted value. Values of FFR below 0.75–0.8 are considered to be associated with myocardial ischemia.
Which of the procedures does the coronary revascularization depend on majorly?
Coronary revascularization majorly depends on angiography to analyze the blockage in the blood vessel.
FFR is limited in patients with which disorders?
FFR is limited in patients with diffuse coronary disease, left ventricular hypertrophy, and small vessel disease, and hence, they are restricted from undergoing the procedure.
What are the advantages of FFRangio from a clinical perspective compared to the standard FFR?
FFRangio is a new procedure in the clinical setting and has high sensitivity, accuracy, and specificity compared to the standard FFR.
How often is the procedure of FFR used?
FFR is a significantly underutilized procedure which is used for only 6.1% of intermediate coronary stenosis intervention.
Which technique is used to assess stenosis?
Stenosis is assessed by angiography.
When was the procedure of FFR introduced?
In the 1990s, the FFR procedure was introduced to select physiologically significant stenosis.
Why do these limitations arise in the patients?
The patients have limitations due to the underestimated severity of coronary stenosis due to the restricted blood flow after administering vasodilators.
Advanced Technology & Facilities
During a routine coronary angiogram, the measurement of the FFR can be done using a pressure wire under a maximum myocardial hyperemia condition. The ratio of coronary arterial stenosis and coronary pressure distal can be calculated to understand the decreased coronary flow distal to the coronary stenosis.
Patients who are candidates for this procedure have stable coronary artery disease. The process is done using invasive coronary angiograms to determine the degree of potential ischemia due to coronary stenosis.
Compared to angiographic-only guidance, ischemia-guided coronary revascularization has been shown to improve outcomes and reduce costs and hospitalization time.
The healthcare provider will be performing the FFR test and will:
Insert a needle with a catheter through the neck, arm, or groin after injecting local anesthesia.
Use fluoroscopy X-ray to guide the catheter towards the aorta and to the coronary arteries.
Inject a dye to make the blockage in the coronary arteries visible with the help of an ultrasound device.
Administer blood thinning medication like heparin before using the pressure sensor on the catheter to measure the pressure on each side of the narrowed coronary artery.
Give a medicine to increase blood flow, like adenosine or papaverine, in the blocked artery to measure the highest blood flow (maximum hyperemia) for an accurate ratio.
Perform angioplasty and stenting if needed, and the FFR can be measured again.
Remove the catheter when the procedure is complete and FFR is normal.
For the calculation of the FFR, the pressure ratio of distal to the blockage to proximal to the blockage is taken.
FFR = pressure distal to the blockage/pressure proximal to the blockage.
Depending on the value of the ratio obtained, the course of treatment can be determined and categorized as gray zone, which can be treated via vascularization and medication; ischemic-producing blockage, which can be treated via vascularization; and non-ischemic-producing blockage, which can be treated with medication.
After the procedure of FFR, complications and discomfort are rare in most patients. If angioplasty and stenting are performed, the patient may have to spend the night in the hospital; otherwise, they can leave within a few hours. The care after the FFR procedure will be explained to the patient by the healthcare provider.
Other FFR indications evaluated in particular clinical scenarios include:
Diffuse atherosclerosis
Multivessel diseases
Left coronary artery stenosis
Coronary artery bypass grafting
Sequential stenosis
There are no contraindications for the FFR test apart from patients with severe hypotension, obstructive pulmonary disease, prolonged QT intervals, atrioventricular blockage, and sick sinus syndrome without a pacemaker. These conditions are contraindicated for the admission of adenosine intravenously during the procedure.
Patients with diabetes mellitus and geriatrics may affect the accuracy of FFR when performed. In geriatric patients, age-related microvascular changes can lead to higher FFR value observation irrespective of the degree of stenosis.
Similarly, patients with diabetes mellitus have elevated FFR values, which are false due to microvascular physiology during the disease and impaired response to vasodilators administered during the procedure.
In the case of the two conditions mentioned earlier, the treatment outcome in the patients can be reduced when the FFR values are followed according to the guidelines.
Benefits:
The blood pressure of the narrowed blood vessels can be measured.
The value of the blood pressure inside the blood vessels will aid the doctors in determining the course of treatment.
Risks:
Adenosine, which is injected, can cause shortness of breath and chest pain. This reaction is expected as when the drug enters the blood system, the blood flow is at its peak.
Papaverine, another drug to increase blood flow, can lead to arrhythmia, which can last for a short duration.
Other risks may be due to cardiac catheterization.
A false normal result can be obtained when the smallest arteries (coronary arterioles) do not respond to the medication that increases blood flow during the procedure.
