Fractional flow reserve-guided percutaneous coronary intervention: where to after FAME 2?
Authors van de Hoef T, Meuwissen M, Piek J
Received 31 May 2015
Accepted for publication 26 August 2015
Published 3 December 2015 Volume 2015:11 Pages 613—622
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Jaya Mallela
Peer reviewer comments 4
Editor who approved publication: Professor Daniel Duprez
Tim P van de Hoef,1 Martijn Meuwissen,2 Jan J Piek1
1AMC Heartcentre, Academic Medical Center, University of Amsterdam, Amsterdam, 2Amphia Hospital, Breda, the Netherlands
Abstract: Fractional flow reserve (FFR) is a well-validated clinical coronary physiological parameter derived from the measurement of coronary pressures and has drastically changed revascularization decision-making in clinical practice. Nonetheless, it is important to realize that FFR is a coronary pressure-derived estimate of coronary blood flow impairment. It is thereby not the same as direct measures of coronary flow impairment that determine the occurrence of signs and symptoms of myocardial ischemia. This consideration is important, since the FAME 2 study documented a limited discriminatory power of FFR to identify stenoses that require revascularization to prevent adverse events. The physiological difference between FFR and direct measures of coronary flow impairment may well explain the findings in FAME 2. This review aims to address the physiological background of FFR, its ambiguities, and its consequences for the application of FFR in clinical practice, as well as to reinterpret the diagnostic and prognostic characteristics of FFR in the light of the recent FAME 2 trial outcomes.
Keywords: fractional flow reserve, coronary flow, stable ischemic heart disease
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