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Physiology Guided Angina Assessment
Physiology Indices

WHY USING PHYSIOLOGICAL INDICES IS ESSENTIAL

Physiological measurements, including hyperemic (FFR) and non-hyperemic pressure ratios (NHPR), Index of Microcirculatory Resistance (IMR), and Coronary Flow Reserve (CFR) are used to assess for epicardial disease and microvascular dysfunction. Physiologic data from PressureWire™ X Guidewire leads to informed decision-making that is proven to improve patient outcomes and prevent unnecessary, repeat hospitalizations.1

Physiological Indices Defined

Objective Diagnosis of Epicardial Disease and Microvascular Dysfunction

View how PressureWire™ X Guidewire measures Fractional Flow Reserve (FFR), Resting Full-cycle Ratio (RFR), Index of Microcirculatory Resistance (IMR) and Coronary Flow Reserve (CFR).

Assessing Ischemia with FFR and RFR Video
Assessing Microcirculation with IMR and CFR


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Physiology-Guided Decision Making Leads to Better Outcomes

Determining the Need for Revascularization
DETERMINING THE NEED FOR REVASCULARIZATION
Assessment For a Coronary Microvascular Dysfunction Diagnosis
ASSESSMENT FOR A CORONARY MICROVASCULAR DYSFUNCTION DIAGNOSIS

Society Guidelines for Physiologic Indices

  Diagnosing Epicardial Stenosis Diagnosing Coronary Microvascular Dysfunction
  FFR RFR IMR CFR
Guidelines ACC/SCAI (view here)
 ESC Guideline 2019 (view here)
AHA/ACC Guidelines (view here)
Cutoff Value ≤ 0.82 ≤ 0.893 ≥ 251,* < 2.51,*
Formula Pd/Pa at hyperemia Lowest Pd/Pa ratio of whole-cycle Pd x Hyperemic Flow Hyperemic Flow/Baseline Flow
Hyperemia Yes No Yes Yes

*IMR and CFR cutoffs in population of ischemia with no obstructive coronary artery disease (INOCA) patients, CorMicA trial.1

RFR is recognized by the Appropriate Use Criteria with an approved coding recommendation by ACC/SCAI.

Assessing Whether Epicardial Stenosis Needs intervention because there’s more to CAD than an angiogram shows
 

FFR — Fractional Flow Reserve + RFR — Resting Full-Cycle Ratio

Assessing Coronary Microvascular Dysfunction (CMD) Because CMD May Contribute to PERSISTENT Angina
 

CFR — Coronary Flow Reserve + IMR — Index of Microcirculatory Resistance

References

  1. Ford TJ, et al. 1-year outcomes of angina management guided by invasive coronary function testing (CorMicA). J Am Coll Card Intu. 2020;13:33-45.
  2. Jeremias A, et al. A test in context: fractional flow reserve: accuracy, prognostic implications, and limitations. J Am Coll Cardiol. 2017;69(22):2748-2758.
  3. Kobayashi Y, et al. Agreement of the resting distal to aortic coronary pressure with the instantaneous wave-free ratio. J Am Coll Cardiol. 2017;70(17):2105-2113.

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