What is FFR and CFR?

At TCT Connect 2020, Nils Johnson presented the results of the DEFINE-FLOW study. Carlos Collet provides a summary of the key messages. Coronary artery disease can be invasively assessed by means fractional flow reserve (FFR) or coronary flow reserve (CFR).


What is CFR in the heart?

The ratio between resting and maximal possible coronary blood flow is the coronary flow reserve (CFR). CFR can be thought of as the capacity of the coronary circulation to dilate and thus increase flow following an increase in myocardial metabolic demands.

What is meant by FFR?

Background. Fractional flow reserve (FFR) measurement involves determining the ratio between the maximum achievable blood flow in a diseased coronary artery and the theoretical maximum flow in a normal coronary artery. An FFR of 1.0 is widely accepted as normal.


What is FFR and RFR?

Resting full-cycle ratio (RFR): a novel physiologic index compared to Fractional Flow Reserve (FFR) in assessing the hemodynamic severity of a coronary stenosis: ILUMIEN I + PREDICT. EuroPCR 2018.

What is FFR and iFR in cardiology?

Background. The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy.


FFR,iFR,CFR Mayo Clinic Interventional Cardiology 2019



What is the normal FFR value?

A normal result ranges from 0.94 to 1. Any number below that means you need some type of treatment because your blood flow is less than what it should be. For example, if your FFR is 0.75, your narrow section of the coronary artery is causing a 25% decrease in pressure.

What does negative FFR mean?

For the most part, a negative FFR predicts the ability to safely defer interventional treatment of an intermediate lesion, with a relatively low risk of downstream events.

Why is the FFR important?

Fractional flow reserve (FFR)–guided revascularization has been shown to be superior to angiography-guided revascularization in reducing both short- and long-term major adverse cardiovascular events (MACE),1,2 and deferral of nonischemic lesions has been associated with improved outcomes.


How do you calculate FFR?

The FFR is determined by measuring the mean aortic pressure, P A ( H ) , and the mean pressure distal to the stenosis, P D ( H ) , during hyperemia, and by the subsequent calculation of the ratio FFR = P D ( H ) / P A ( H ) .

Is iFR and RFR the same?

Conclusions: RFR is diagnostically equivalent to iFR but unbiased in its ability to detect the lowest Pd/Pa during the full cardiac cycle, potentially unmasking physiologically significant coronary stenoses that would be missed by assessment dedicated to specific segments of the cardiac cycle.

Is FFR a gold standard?

Expert commentary: FFR is still unsurpassed in diagnostic performance when compared to non-hyperemic indices and noninvasive techniques, and remains the gold standard for the detection of ischemia-inducing coronary stenoses.


What is flow limiting stenosis?

A flow-limiting stenosis is the major determinant of exercise-induced myocardial stunning in patients with coronary artery disease. J Cardiol.

What is abnormal CFR?

In individuals without heart conditions, CFR can be measured at a 3, which means coronary circulation can be tripled when needed. An abnormal rating of CFR is typically around 2.

What are the 3 cardiac markers?

Cardiac enzymes ― also known as cardiac biomarkers ― include myoglobin, troponin and creatine kinase. Historically, lactate dehydrogenase, or LDH, was also used but is non-specific. Cardiac enzymes are released into the circulation when myocardial necrosis occurs, as seen in myocardial infarction.


What is a fatal ejection fraction?

A low number can be serious. If your ejection fraction is 35% or below, you're at high risk of developing a dangerous arrythmia or even heart failure.

How often is FFR used?

Despite long-term data showing improved outcomes with FFR-guided decision-making, its use remains significantly underutilized in practice, with FFR being used in 6.1% of interventions for intermediate coronary lesions (40-70% stenosis).

Is FFR mandatory?

Except for awards under SNAP and awards that require more frequent reporting, the FFR is required on an annual basis. When required on an annual basis, the report must be submitted for each budget period no later than 90 days after the end of the calendar quarter in which the budget period ended.


Who controls the FFR?

The Federal Open Markets Committee (FOMC) sets the federal funds rate—also known as the federal funds target rate or the fed funds rate—to guide overnight lending among U.S. banks. It's set as a range between an upper and lower limit. The federal funds rate is currently 4.25% to 4.50%.

When is FFR due?

When the time comes for you to submit the Annual FFR, use the FFR record that reflects a due date of July 29, 2022 (which is really the due date for your Final FFR, 120 days after the end of the project period).

What medication is used with FFR?

Objective Measuring the fractional flow reserve (FFR) requires the induction of coronary hyperemia, usually with adenosine, adenosine triphosphate (ATP), or papaverine.


What is a good coronary flow reserve?

The normal value for coronary flow reserve is greater than 2 to 2.5. This means that under stress (exertion), you have double the amount of blood flow to your heart that you have while at rest.

What is the most common coronary artery anomaly?

The coronary most frequently involved is the RCA and is reported with increased frequency in patients with a bicuspid aortic valve. This anomaly is benign most of the time, but may complicate coronary catheterization and its identification is important before an aortotomy.

What is severe LAD disease?

Fatty deposits of plaque can build up inside the LAD artery, leading to atherosclerosis or “hardening of the arteries.” In some people, so much plaque accumulates inside the LAD artery that a complete blockage occurs. Oxygenated blood can't reach the heart, causing an often-fatal heart attack known as a widowmaker.


What is a severe coronary lesion?

These severe lesions include serious coronary stenosis and dilation with aneurysms. The long-term complications related to the persistence of these lesions have the strongest association with myocardial infarction (MI) and sudden cardiac death (SCD).

What level of stenosis requires surgery?

Surgery isn't recommended in cases where there's minor stenosis (less than 50%). This is because surgery is most beneficial for people with moderate and severe stenosis (more than 50%). The maximum benefit is seen in those with severe stenosis (70 to 99%).