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(Circulation. 1995;92:3183-3193.)
© 1995 American Heart Association, Inc.

Articles

Fractional Flow Reserve

A Useful Index to Evaluate the Influence of an Epicardial Coronary Stenosis on Myocardial Blood Flow

Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14-17, 1994.

Nico H.J. Pijls, MD, PhD; Berry Van Gelder, MSc; Pepijn Van der Voort, MD; Kathinka Peels, MD; Frank A.L.E. Bracke, MD; Hans J.R.M. Bonnier, MD, PhD; Mamdouh I.H. El Gamal, MD

From the Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands.

Correspondence to Nico H.J. Pijls, MD, PhD, Department of Cardiology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, Netherlands.

Background Fractional flow reserve (FFR), defined as the ratio of maximum flow in the presence of a stenosis to normal maximum flow, is a lesion-specific 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 aims of this study were to define ranges of FFR values, whether associated with inducible ischemia or not, and to investigate FFR in normal coronary arteries.

Methods and Results In 60 patients accepted for percutaneous transluminal coronary angioplasty (PTCA) of single-vessel disease, with a positive exercise test (ET) <24 hours before PTCA, FFR was determined during adenosine-induced hyperemia just before and 15 minutes after angioplasty. P_a was measured by the guiding catheter, P_d by an 0.018-in fiber-optic pressure-monitoring wire, and P_v by a multipurpose catheter. The ET was repeated after 5 to 7 days, and only if this second ET had reverted to normal was the pre-PTCA value of FFR definitely considered to be associated with inducible ischemia and the post-PTCA value not.

Myocardial FFR (FFR_myo) increased from 0.53±0.15 before PTCA to 0.88±0.07 after PTCA. Coronary FFR increased from 0.38±0.19 to 0.83±0.12. In all patients, values of FFR_myo definitely associated with ischemia were 0.74, whereas all except two values not associated with inducible ischemia exceeded 0.74. Moreover, FFR_myo in 18 coronary arteries in 5 normal patients equaled 0.98±0.03.

Conclusions A value of FFR_myo of 0.74 reliably discriminates coronary stenosis, whether associated with inducible ischemia or not. Therefore, FFR_myo is a useful index to determine the functional significance of an epicardial coronary stenosis and may facilitate clinical decision making in patients with an equivocal coronary stenosis.

Key Words: fractional flow reserve • collateral circulation • blood flow

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				A. S. Abizaid, G. S. Mintz, R. Mehran, A. Abizaid, A. J. Lansky, A. D. Pichard, L. F. Satler, H. Wu, C. Pappas, K. M. Kent, et al. Long-Term Follow-Up After Percutaneous Transluminal Coronary Angioplasty Was Not Performed Based on Intravascular Ultrasound Findings : Importance of Lumen Dimensions Circulation, July 20, 1999; 100(3): 256 - 261. [Abstract] [Full Text] [PDF]

				T. Nishioka, A. M. Amanullah, H. Luo, H. Berglund, C.-J. Kim, T. Nagai, N. Hakamata, S. Katsushika, A. Uehata, B. Takase, et al. Clinical validation of intravascular ultrasound imaging for assessment of coronary stenosis severity: Comparison with stress myocardial perfusion imaging J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1870 - 1878. [Abstract] [Full Text] [PDF]

				P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]

				C. E. E. Hanekamp, J. J. Koolen, N. H. J. Pijls, H. R. Michels, and H. J. R. M. Bonnier Comparison of Quantitative Coronary Angiography, Intravascular Ultrasound, and Coronary Pressure Measurement to Assess Optimum Stent Deployment Circulation, March 2, 1999; 99(8): 1015 - 1021. [Abstract] [Full Text] [PDF]

				G. J. W. Bech, N. H. J. Pijls, B. De Bruyne, K. H. Peels, H. R. Michels, H. J. R. M. Bonnier, and J. J. Koolen Usefulness of Fractional Flow Reserve to Predict Clinical Outcome After Balloon Angioplasty Circulation, February 23, 1999; 99(7): 883 - 888. [Abstract] [Full Text] [PDF]

				N H J Pijls and B De Bruyne Coronary pressure measurement and fractional flow reserve Heart, December 1, 1998; 80(6): 539 - 542. [Full Text]

				D. Baumgart, M. Haude, G. Goerge, J. Ge, S. Vetter, N. Dagres, G. Heusch, and R. Erbel Improved Assessment of Coronary Stenosis Severity Using the Relative Flow Velocity Reserve Circulation, July 7, 1998; 98(1): 40 - 46. [Abstract] [Full Text] [PDF]

				N. H.J. Pijls, B. de Bruyne, K. Peels, P. H. van der Voort, H. J.R.M. Bonnier, J. Bartunek, and J. J. Koolen Measurement of Fractional Flow Reserve to Assess the Functional Severity of Coronary-Artery Stenoses N. Engl. J. Med., June 27, 1996; 334(26): 1703 - 1708. [Abstract] [Full Text] [PDF]

				H. Matsuo, S. Watanabe, T. Kadosaki, T. Yamaki, S. Tanaka, S. Miyata, T. Segawa, Y. Matsuno, M. Tomita, and H. Fujiwara Validation of Collateral Fractional Flow Reserve by Myocardial Perfusion Imaging Circulation, March 5, 2002; 105(9): 1060 - 1065. [Abstract] [Full Text] [PDF]