Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation

Abstract

Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance ofepicardial coronary stenosis. Despite the overall trend towards more physiology-guided revasculari-zati-on, there remains a gap, between guideline recommendations and the clinical adoption of functional evaItAatiorl of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologi'es, we sought to highlight the pri'nci'ples, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization Laboratory. Computational FFR has the potential to ex Pand and facilitate the use of physiology for diagnosis, procedural guidance, and evaluation of therapies, with anticipated impact on resource utilization and patient outcomes.