Why Physiology | Abbott’s Portfolio | Drift | Pressure Ratios Landscape | Clinical Outcomes
Angiography is often used for diagnosing coronary artery disease, but is unable to accurately capture the plaque morphology and eccentricity of an epicardial stenosis. As a result, angiography fails to look beyond the stenosis to objectively understand the extent of ischemia.1
Physiological measurements, also known as hyperemic (FFR) and non-hyperemic pressure ratios (NHPR), are used to evaluate the functional significance of coronary stenosis. Routine adoption of physiology in clinical practice allows the physician to make the right decision for the right patient, at the right time.
Watch physician experts discuss the important factors to look for when measuring coronary physiology and explain why technique and the right tools matter.
The benefits of using coronary physiology include:
Abbott’s PressureWire™ X Guidewire can measure Resting Full-Cycle Ratio (RFR) and Fractional Flow Reserve (FFR).
RFR scans through diastole and systole for the largest drop in pressure in the entire cardiac cycle.
RFR has been studied in over 3,500 lesions and 2,500 patients3,6-9 and RFR has shown diagnostic equivalence to iFR‡.10
FFR is a ratio of the (Pd) distal to the lesion coronary pressure divided by (Pa) aortic pressure proximal to the stenosis during maximal hyperemia.
FFR measured by the PressureWire™ X Guidewire is a risk stratification tool that helps guide revascularization, as seen in the FAME and FAME 2 trials.11
PressureWire™ X Guidewire is the only wire with 4 connection options to eliminate clutter and meet your labs needs.
PressureWire™ X Guidewire offers objective decisions with a simplified workflow. The new innovative sensor housing design of PressureWire™ X Guidewire has technology to improve12 measurement accuracy.
Previous Sensor Housing Design
NEW Sensor Housing Design
RFR is recognized by the Appropriate Use Criteria with an approved coding recommendation by ACC/SCAI.
Drift is a phenomenon that affects the accuracy of most pressure measurement devices.13 Accuracy is particularly critical for resting ratios, as clinical decisions from resting ratios are more impacted by drift than FFR.14,15
Compared to the hyperemic state, smaller separation between Pd and Pa at rest means even relatively small amounts of drift can lead to stenosis misclassification compared to FFR. That’s why it critical to detect even the slightest difference of pressure.
There are several hyperemic and NHPR available to an interventional cardiologist today.
FFR = fractional flow reserve
iFR‡ = instantaneous wave-free ratio (Philips)
RFR = resting full-cycle ratio (Abbott)
IRIS-FFR is a large retrospective study (n = 1,506 patients, 1,833 lesions) evaluating outcomes of resting ratios; its median follow-up was 1.1 years. The analysis examined deferred lesion failure (DLF) among 5 resting indices—resting Pd/Pa, iFR‡, RFR™, dPR‡ and DFR‡- and concluded that all resting indices had similar outcomes in deferred lesions.14
These results suggest a “class effect” among non-hyperemic pressure ratios. Guidelines and clinical recommendations can therefore be applied in the same manner.14
| Pd/Pa Full Cycle Average |
Diastolic Pressure Ratios |
RFR Full Cycle |
|
|---|---|---|---|
| Accuracy vs. FFR1 | 85% | 83% | 84% |
| Cutoff2 | ≤0.91 | ≤0.89 | ≤0.89 |
| Hyperemia Needed1 | No | No | No |
| Clinical Decision Making1 | Equivalent | ||
| Outcomes1 | Equivalent | ||
| Pullback Sensitivity3 | Medium | High | High |
1. Ahn, JM., et al. IRIS-FFR: prognostic performance of five resting pressure-derived indexes of coronary physiology. TCT2018. |
|||
| Non-Hyperemic | FFR | |
|---|---|---|
| Multi-vessel Disease1 | +++ | +++ |
| LMCA2 | - | +++ |
| LAD3 | +++ | ++ |
| Tandem Lesions4 | +++ | + |
| Diffuse Disease5 | +++ | + |
| ACS6 | +++ | ++ |
| DM7 | +++ | +++ |
| Systolic Dysfunction8 | - | +++ |
| Post-PCI SB Interrogation9 | - | +++ |
| Post-PCI Assessment10 | - | +++ |
1. Eur Heart J. 2017 Nov 7;38(42):3124-3134. 2. Catheter Cardiovasc Interv. 2015 Jul;86(1):12-8. 3. JACC 2019 Feb 5;73(4):444-453. 4. JACC Int 2014 Dec;7(12):1386-96. 5. Define PCI ACC 2019. 6. JACC Int 2018 Aug 13;11(15):1437-1449. 7. JAMA Cardiol 2019 Jul 17. 8. Eur Heart J. 2019 Aug 16. 9. JACC 2005 Aug16;46(4):633-7. 10. JACC 2014 Oct 21;64(16):1641-54. Chart courtesy of Ziad Ali, MD. |
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As a leader in PCI, Abbott also has a rich legacy of supporting research, developing products and advancing technology related to coronary physiology. Abbott’s accomplishments offer interventional cardiologists key data as well as cutting-edge technology.
References
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