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Practical Tips on FFR
(Fractional Flow Reserve)

Head, Department of Cardiology
Director of Cardiac Catheterization Labororatory,
Director of Medical Informatics,

National Heart Centre Singapore
10/2012


FFR Practical Tip


Easier Set-Up

• Wireless integration with
hemodynamic system
• Automatic wire zeroing and
calibration
• Plus-and-play
• Can work with any
hemodynamic system





FFR Practical Tip

• Borderline lesion

• Multi-vessel disease
• Ostial lesion



FFR-Guided
PCI performed on
indicated lesions
only if FFR <0.80

Lesions warranting
PCI identified

Randomized

Angio-Guided
PCI performed on
indicated lesions

• Before randomization the operator indicated all stenoses
≥ 50% requiring stenting and
classified them into: 50-70%, 71-90% and 91-99%
• In the FFR-group all indicated lesions were measured
by FFR (N=1329)


Almost all stenoses >90% narrowed are significant
by FFR
65%

20%

20%
4%

35%

P. Tonino, et al, J Am Coll Cardiol 2010;55:2816–21


Pre Stent

Post Stent

FU @ 8 mo
Courtesy of Chang-Wook Nam, MD


Jailed Side Branches and FFR
FFR in 97 “Jailed” Side Branches

53/73 (73%)
of all lesions
> 75% stenosis
0.75

At 10 month F/U no
Death, MI, or
Sidebranch TLR

Koo et al. J Am Coll Cardiol 2005;46:633-7.


FFR Practical Tip


Too big  pressure wedging when engaging coronary
Too small  dampens the aortic signal


Impact of Catheter Size on Hyperemic Flow

Beware of pressure damping

De Bruyne et al. Cathet Cardiovasc Diagn 1994;33:145-152.


Using diagnostic catheter
more friction with guidewire
smaller inner lumen  pressure transmission
may be dampened
in case of wire causing coronary dissection 
will need to exchange for guiding catheter to
perform emergency PCI


Effect of Using catheter with sideholes

Pressure recorded by the guide cath (Pa) is influenced by coronary pressure
via guide lumen and aortic pressure via side-holes. Pa may be lower than

the value recorded by the guide catheter leading to a false –ve FFR.


FFR Practical Tip


Sensor just outside tip of
guiding catheter

TCT 24.09.09



Damped pressure

** ensure adequate
flushing.


1

2

Causes - large guide, small vessel, ostial disease.
Solution - Disengage the guide catheter during the FFR measurement.
DO NOT use an IC (intra-coronary) hyperaemic stimulus.



TCT 24.09.09

TCT
24.09.09