Wire-Free and Adenosine-Free Fractional Flow Reserve Derived From the Angiogram
A Promising Future Awaiting Outcomes Data
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Invasive measurement of coronary arterial stenosis pressure gradients during maximal arteriolar vasodilation provides key physiological insights into ischemia-producing lesions that drive clinical outcomes before and after percutaneous coronary intervention.1–4 Although invasive coronary pressure gradients obtained during maximal hyperemic flow (ie, fractional flow reserve [FFR]) in patients with coronary artery disease do not provide a quantitative measure of absolute myocardial perfusion,5 FFR-guided coronary revascularization improves symptoms and reduces major adverse cardiovascular events (primarily target vessel revascularization),6,7 and may improve prognosis in patients with a large burden of ischemia.5
See Article by Westra et al
The measurement of FFR requires placement of a coronary guidewire within the artery of interest followed by induction of maximal coronary artery hyperemic flow, usually by infusion of intravenous adenosine. The instrumentation of the coronary circulation and use of a systemic vasodilator required to perform FFR are associated with small but nontrivial increases in cost, risk, and time, with limited reimbursement for such procedures. These limitations are reflected in the remarkably low adoption of invasive FFR in the real world.8
To address these barriers, several noninvasive and invasive alternatives to invasive FFR have emerged.9–17 Among the panoply of FFR alternatives, only the instantaneous wave-free ratio (iFR), an adenosine-free approach, has been shown to perform …