Novel Indices of Coronary Physiology: Do We Need Alternatives to Fractional Flow Reserve?

Circ Cardiovasc Interv. 2020 Apr;13(4):e008487. doi: 10.1161/CIRCINTERVENTIONS.119.008487. Epub 2020 Apr 16.

Abstract

Fractional flow reserve is the current invasive gold standard for assessing the ischemic potential of an angiographically intermediate coronary stenosis. Procedural cost and time, the need for coronary vessel instrumentation, and the need to administer adenosine to achieve maximal hyperemia remain integral components of invasive fractional flow reserve. The number of new alternatives to fractional flow reserve has proliferated over the last ten years using techniques ranging from alternative pressure wire metrics to anatomic simulation via angiography or intravascular imaging. This review article provides a critical description of the currently available or under-development alternatives to fractional flow reserve with a special focus on the available evidence, pros, and cons for each with a view towards their clinical application in the near future for the functional assessment of coronary artery disease.

Keywords: angiography; computed tomography; coronary artery disease; fractional flow reserve; hyperemia; intravascular imaging.

Publication types

  • Review

MeSH terms

  • Cardiac Catheterization* / instrumentation
  • Cardiac Catheters
  • Cardiac Imaging Techniques*
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / physiopathology
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / physiopathology
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Transducers, Pressure