Reviews

DOI: http://doi.org/10.31928/2305-3127-2019.3.513 

Fractional flow reserve: current status

A.V. Khokhlov, M.V. Shymanko, M.V. Stan 

Heart Institute, Ministry of Health of Ukraine, Kyiv, Ukraine

Since the introduction of the fractional flow reserve (FFR) into clinical practice more than 20 years ago, revascularization controlled by the measurement of physiological parameters has become routine. It was substantiated by extensive evidence in both chronic coronary artery disease and acute coronary syndrome. Also, recently, a non-wavelength study of coronary flow, «instant-wave fractional reserve» (iFR) has been introduced into practice, which allows the use of vasodilators to be abandoned. Despite evidence of significant improvement in case of FFR and iFR study, their use in everyday practice remains very low. According to literature data, only 6.1% of interventions in patients with intermediate coronary lesions (stenosis 40–70%) are performed taking into account FFR and iFR. The article analyzes the literature on the application of the methodology for studying the fractional reserve of coronary blood flow to optimize the results of coronary revascularization. Methods of studying the fractional coronary flow reserve (FFR and iFR) are a relatively simple tool that allow to answer the main question of interventional cardiology, i.e. "Is it necessary to stent this stenosis?”, quickly and with high degree of reliability. During recent years, these techniques developed from experiment to daily routine practice. Also, these techniques are not as complicated as intravascular ultrasound (IVUS), being much cheaper and can be used by a wider range of operators. The iFR method, in addition, allows not to use vasodilator, which makes it safer, easier and cheaper. A huge amount of evidence of the diagnostic value of these methods has been accumulated with a sufficient level of safety of their use. The technical simplicity of techniques, which reduces the cost of material and human resources, makes it particularly attractive for use in everyday practice, even in mid-level clinics.

Key words: fractional flow reserve, coronary stenting, revascularization, coronary artery desease.