Boutaleb AM, Ghafari C, Ungureanu C, Carlier S. Fractional flow reserve and non-hyperemic indices: Essential tools for percutaneous coronary interventions. World J Clin Cases 2023; 11(10): 2123-2139 [PMID: 37122527 DOI: 10.12998/wjcc.v11.i10.2123]
Corresponding Author of This Article
Stéphane Carlier, MD, PhD, Professor, Department of Cardiology, University of Mons, Pentagone, Aile 2, Avenue du Champ de Mars, 6, Mons 7000, Belgium. stephane.carlier@umons.ac.be
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Evidence Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Amine Mamoun Boutaleb, Department of Cardiology, Ibn Rochd University Hospital, Casablanca 20230, Casablanca, Morocco
Amine Mamoun Boutaleb, Stéphane Carlier, Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, Mons 7000, Belgium
Chadi Ghafari, Claudiu Ungureanu, Stéphane Carlier, Department of Cardiology, University of Mons, Mons 7000, Belgium
Claudiu Ungureanu, Catheterization Unit, Jolimont Hospital, La Louvière 7100, Belgium, Belgium
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stéphane Carlier, MD, PhD, Professor, Department of Cardiology, University of Mons, Pentagone, Aile 2, Avenue du Champ de Mars, 6, Mons 7000, Belgium. stephane.carlier@umons.ac.be
Received: December 27, 2022 Peer-review started: December 28, 2022 First decision: February 8, 2023 Revised: February 22, 2023 Accepted: March 15, 2023 Article in press: March 15, 2023 Published online: April 6, 2023 Processing time: 92 Days and 16.5 Hours
Abstract
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.
Core Tip: Fractional flow reserve and non-hyperemic indices are the cornerstone for optimal percutaneous interventions. In this extensive review we discuss their rationale of use, indications guidelines, benefits and pitfalls. The comprehensive use of coronary artery physiology for the guidance of percutaneous interventions may be beneficial for every interventional cardiologist. Hence, we aimed to make a clear statement of physiology-guided percutaneous interventions to enhance coronary artery revascularization techniques.
