Diagnostic accuracy of a novel onsite virtual fractional. Standardization of fractional flow reserve measurements. Background fractional flow reserve ffrguided percutaneous coronary intervention pci is associated with improved clinical and economic outcomes compared with angiographic guidance alone. The coronary pressure flow relation at maximum hyperaemia is indicated both for a normal coronary artery and a coronary stenosis. Features of coronary flow reserve cfr and fractional flow reserve ffr.
Crf is committed to igniting the next wave of innovation in research and education that will help doctors save and improve the quality of their patients lives. Pressure wirebased fractional flow reserve is considered the standard of reference for evaluation of the ischemic potential of coronary stenoses and the expected benefit from revascularization. The index ffr fractional flow reserve is based upon the two following principles. Click for larger image download as powerpoint slide. Other patients have moderate coronary lesions with between 50. Fractional flow reserve free download as powerpoint presentation. Assistant professor division of cardiovascular medicine stanford university medical center imaging and physiology summit seoul, korea friday, november 20th, 2009. The original description of ffr required the induction of maximal hyperemia to achieve near linear correlation between coronary pressure and blood flow. Even though large studies, such as the fame fractional flow reserve versus angiography for multivessel evaluation and fame ii studies established a binary ffr cutoff of 0.
Fractional flow reserve ffr is a technique to evaluate the hemodynamic relevance of coronary artery stenoses 1,2, it is defined as the ratio of maximal flow achievable in the stenotic coronary artery to the maximal flow achievable in the same coronary artery if it was normal 1. Fractional flow reserve cardiovascular hemodynamics for. In this chapter we will focus on the role of the coronary pressure wire to measure fractional flow reserve ffr and guide decisions regarding coronary revascularization. Were speaking about fractional flow reserve ffr a simple, quick measurement that can be done as part of diagnostic angiography and one which will measure the functional significance of a specific lesion or lesions i. Ffr is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow in the same artery if there were no stenosis. Ffr has become the gold standard method for assessing coronary lesion severity during invasive coronary. Virtual vffr can be calculated based upon a 3dimensional 3d reconstruction of the coronary anatomy from the angiogram, using computational fluid dynamics cfd modeling. Competitive flow is dynamic, relative, and to a certain extent unavoidable. Objectives the purpose of this study was to evaluate the diagnostic.
Percutaneous coronary intervention, coronary angiography, hemodynamics, fractional flow reserve, myocardial, coronary stenosis. Accordingly, its application in daily practice or for research purposes has to be as standardized as possible to avoid technical or operatorrelated artifacts in pressure recordings. The normal value of ffr is 1 whatever the patient, the territory, the systemic haemodynamics, the size of the vessel or the myocardial mass. Fractional flow reserve versus angiography for guiding. Both of these aspects agree with the experimental observations in the table. Tct 2018 presentation slides fastffr american college of. Role of postintervention fractional flow reserve to.
With the administration of intravenous adenosine, the fractional flow ratio decreases to 0. As opposed to anatomical approaches, physiological measurements particularly pressurederived ffr assess the function of the coronary circulation and offer the possibility of ad hoc treatment. Fractional flow reserve based on the principle that the distal coronary pressure measured during vasodilation is directly proportional to maximum vasodilated perfusion. Coronary artery disease, fractional flow reserve, revascularisation. Fractional flow reserve ffr is a technique used in cardiac catheterization to determine the likelihood that a coronary artery stenosis impedes oxygen delivery to the heart. Fractional flow reserve ffr is a physiologic parameter which can be measured easily during the invasive procedure and can assess the functional significance of coronary stenosis. Background fractional flow reserve ffr, defined as the ratio of maximum flow in the presence of a stenosis to. Twentythree stable cad patients underwent oneday dynamic reststress 99mtcsestamibi myocardial perfusion imaging by czt camera. Concept and setup for fractional flow reserve concept and setup for fractional flow reserve william f. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. Under resting conditions, autoregulation maintains a largely constant blood flow and therefore a constant pressure loss, corresponding to a stable nonhyperemic pressure ratio.
We hypothesise that caffeine, being a competitive inhibitor of adenosine, would influence adenosinemediated ffr readings. Background fractional flow reserve ffr, defined as the ratio of maximum flow in the presence of a stenosis to normal maximum flow, is a lesionspecific index of stenosis severity that can be calculated by simultaneous measurement of mean arterial, distal coronary, and central venous pressure p a, p d, and p v, respectively, during pharmacological vasodilation. The background and derivation of ffr were already covered in chapter 6. Cardiovascular centre aalst olvclinic aalst, belgium etp course 2014, sophiaantipolis.
Although it has become the standard of reference for decisionmaking regarding coronary revascularization, the procedure remains underutilized due to its invasive nature. Find powerpoint presentations and slides using the power of, find free presentations research about fractional flow reserve ppt. Clinical use of ctderived fractional flow reserve in the. To define the diagnostic power of absolute myocardial blood flow mbf evaluation on dynamic czt imaging in intermediate risk patients in comparison with invasive coronary angiography ica and fractional flow reserve ffr. The fractional flow reserve market is expected to reach 1,082 million by 2024 from an. Effects of intravenous caffeine on fractional flow reserve. Coronary fractional flow reserve ffr is the reference standard measurement for directing appropriate percutaneous coronary intervention 1. Fractional flow reserve ffr is an invasive measurement developed in 1990s for evaluation of functional significance of stenoses in the epicardial coronary artery. Fractional flow reserve radiology reference article.
Fractional flow reserve ffr utilizes a specialized guide wire to measure blood pressure within a coronary artery. Flow fractional reserve ffr is a physiological measure used to determine the hemodynamic significance of an atherosclerotic lesion, defined as the ratio of the blood pressure distal to the lesion to that of the aorta during adenosineinduced hyperemia. Clinical use of ctderived fractional flow reserve in the emergency. Figure1 download figure open in new tab download powerpoint. Computed tomographic ct ffr technology that noninvasively estimates ffr from ct angiography data by using computational fluid dynamics cfds may deliver cost savings and improved quality of life 2. Fractional flow reserve measurement accurately measured coronary pressure p d accurately measured aortic pressure p a. Fractional flow reserve ffr is a technique used in coronary catheterization to measure pressure differences across a coronary artery stenosis narrowing, usually due to atherosclerosis to determine the likelihood that the stenosis impedes oxygen delivery to the heart muscle myocardial ischemia. Coronary artery stenosis fractional flow reserve assessment. Diagnostic accuracy of a novel onsite virtual fractional flow reserve parallel computing system. Fractional flow reserve ffr, an index of the hemodynamic severity of coronary stenoses, is derived from hyperemic pressure measurements and requires a pressuremonitoring guide wire and hyperemic stimulus.
Determination of ffr is recommended in coronary artery stenoses with a luminal diameter narrowing between 50 % and 90 % if no noninvasive proof of ischaemia is available. Due to the practical limitations of the doppler wire and other methods to calculate coronary flow reserve cfr, the use of a pressure transducer to measure pressure. The use of fractional flow reserve ffr for determining ischemia before coronary intervention has been conclusively demonstrated to improve longterm outcomes in patients with stable ischemic heart disease sihd in comparison with an angiographyalone strategy. Fractional flow reserve derived from coronary computed tomography angiography enables noninvasive assessment of the hemodynamic significance of coronary artery lesions and coupling of the anatomic severity of a coronary stenosis with its physiological effects. It is not resting flow, but maximum achievable flow which determines the. Fractional flow reserve ffr is a reference invasive diagnostic test to assess the physiological significance of an epicardial coronary artery stenosis. Background clinical outcomes following coronary computed tomographyderived fractional flow reserve ffrct testing in clinical practice are unknown. Fractional flow reserve ffr is the extent to which maximal myocardial flow is limited by the presence of an epicardial stenosis. While there is emerging evidence of the clinical benefit of ffr ct in patients with moderate coronary disease as determined with coronary ct angiography, there has been less focus on interpretation. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease. Noninvasive fractional flow reserve derived from coronary. A standard diagnostic catheter at the time of a coronary angiogram, which is also known as cardiac catheterization, is used to perform the fractional flow reserve procedure. Competitive flow reduces the patency of arterial grafts after coronary bypass surgery. A machinelearning approach for computation of fractional.
Performing and interpreting fractional flow reserve. We discuss a deeplearningbased approach for noninvasive computation of coronary fractional flow reserve ffr from computed tomography images. Background intravenous adenosine is used to minimise the coronary microresistance to achieve maximal hyperaemia along with nitrates for optimal fractional flow reserve ffr measurements. Costeffectiveness of fractional flow reserve guided percutaneous coronary intervention in patients with stable coronary disease. Fractional flow reservebased coronary artery bypass. Fractional flow reserve ffr provides an objective measurement of the severity of ischemia caused by coronary stenoses in downstream myocardial regions. Ffrguided revascularization strategy is reported to be more effective than angiographyguided strategy in patients with coronary artery disease. Data from the interventional cardiology realm have suggested benefits of a ffrguided percutaneous coronary intervention pci strategy. Absolute myocardial blood flows derived by dynamic czt. Ffr can be measured during routine coronary angiography using a pressure sensor guidewire to calculate the ratio between. Since its initial demonstration of feasibility of use in humans in 2011, a significant body of clinical evidence has developed to. Fractional flow reserve guided coronary artery bypass grafting is emerging in cardiac surgery, in which the nature anatomic and functional characteristics of the target vessel epicardial coronary artery stenosis is important in graft site selection. Fractional flow reserveguided coronary artery bypass. Background the utility of fractional flow reserve ffr to guide revascularisation in the management of acute coronary syndrome acs remains unclear.
Fractional flow reserve ffr guidance for treatment of nonculprit vessels seems to be a reasonable. Fractional flow reserveguided primary multivessel percutaneous. Noninvasive fractional flow reserve derived from coronary ct angiography ffr ct is increasingly used in patients with coronary artery disease as a gatekeeper to the catheterization laboratory. Ppt costeffectiveness of fractional flow reserveguided. Coronary ct angiographyderived fractional flow reserve. Fractional flow reserve guided pci vs medical therapy mt in stable cad. Results from the fame 2 trial a free powerpoint ppt presentation displayed as a flash slide show on id.
Limited evidence is available on the use of ffr to guide coronary artery bypass grafting cabg. The fractional flow reserve market is projected to grow at a cagr of 16. Coronary pressure measurement and fractional flow reserve. The resting pressure flow relation autoregulatory range. Objective this study aims to compare the clinical outcomes of patients following ffrguided revascularisation for either acs or stable angina sa and in particular focuses on the outcome of those with deferred revascularisation after ffr. Background fractional flow reserve ffr computation from coronary computed tomography angiography cta datasets ffrct has emerged as a promising noninvasive test to assess hemodynamic severity of coronary artery disease cad, but has not yet been compared with traditional functional imaging. View and download powerpoint presentations on fractional flow reserve ppt. Fractional flow reserve ffr is emerging as a useful clinical tool for assessing the functional significance of coronary atherosclerosis. Ffr is defined as a ratio of the maximal myocardial blood flow in the presence of a stenosis to the theoretical normal maximal flow in the same distribution. Objectives this study sought to assess realworld clinical outcomes following a diagnostic strategy including firstline coronary computed tomography angiography cta with selective ffrct testing. Comparison of coronary computed tomography angiography. A noninvasive onsite vffr simulation defined the distal portion of the right coronary artery a as an. Tctmd is produced by the cardiovascular research foundation crf.
826 1217 805 277 389 140 84 182 1217 256 374 20 628 352 1059 406 234 829 1519 809 444 1365 833 1338 810 494 1396 696 226 403 1145 343 81 1435 92