Finding the ratio between the maximum blood flow can be achieved in a diseased coronary artery and the maximum flow that may theoretically achieved in a normal coronary artery is the process of measuring fractional flow reserve (FFR).
Most people agree that an FFR of 1.0 is normal. Myocardial ischemia (MI) is typically linked to an FFR below 0.75 to 0.80.
Using a pressure wire to determine the ratio of coronary pressure distal with a coronary artery stenosis makes it simple to measure FFR during normal coronary angiography.
FFRs obtained from outflow boundary conditions based on conventional morphology largely accord with those based on positron-emission tomography (PET) conditions. The functional severity of coronary artery stenoses has been assessed using computed tomography (CT)-based FFR computations.
MI occur when myocardial blood supply is restricted by coronary artery stenosis. The cardiologist uses visual inspection during cardiac angiography to assess the degree of coronary artery stenosis.
If the luminal diameter narrows by 70% or more, the lesion is usually regarded as serious and flow-limiting.
Indications
To assess the hemodynamic and physiological relevance of coronary stenosis
To determine the relevant lesion or lesions that are the cause of multivessel coronary artery disease (CAD).
In the presence of distal collateral flow to determine the functional significance of stenosis.
In cases where the angiographic image is not clear to determine the exact location of a coronary lesion.
Contraindications
Known Allergy or Hypersensitivity to Adenosine
Severe Asthma or Reactive Airway Disease
Second or Third-Degree Atrioventricular (AV) Block Without a Pacemaker
Hypotension or Hemodynamic Instability
Severe Aortic Stenosis
Left Main Coronary Artery Disease
Severe Anemia
Outcomes
The purpose of the trial was to determine whether skilled interventional cardiologists could use coronary angiography to find individuals with FFRs less than 0.75.
The significance of most mild coronary lesions was not predicted by skilled interventional cardiologists’ angiographic evaluation of an angiography.
The Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) study examined the function of FFR in the assessment of multivessel CAD. The findings of the study indicated that patients with multivessel CAD benefit more from a revascularization approach that uses FFR.
Angiography-identified patients with multivessel CAD were randomized to receive FFR with angiography or angiography alone.
All angiographically serious lesions in the patients in the angiography-only arm were stented. Only patients whose FFR was 0.80 or below were stented in the FFR-plus-angiography arm.
Equipment required
Basic Cardiac Catheterization Equipment
FFR-Specific Equipment
Monitoring and Supportive Equipment
Patient Preparation
The cardiologist determines if FFR measurement is likely to be helpful following a diagnostic cardiac catheterization and the identification of a stenosis.
Prior to cardiac catheterization, patient should typically fast for four to six hours.
For at least 12 to 24 hours before, stay away from coffee since it may interfere with the hyperemia caused by adenosine.
Additional contrast use and radiation exposure are risks unique to the FFR operation, and there is a modest increase in the risk of coronary artery dissection with FFR wire passage.
Informed Consent:
The cardiologist should inform the patient of all the possible risks and advantages of the cardiac catheterization including the potential need for an unforeseen coronary intervention.
Information on stent installation and other invasive evaluation methods, such as fractional flow reserve (FFR) measurement should be discussed in relation to the intervention.
Patient Positioning
The patient is on the procedure table, lying flat. When placing an ECG lead or accessing an IV, the arms are often comfortably at the sides or extended on arm boards.
Technique
For Volcano systems:
Place the spiral on the sterile field after using sterile techniques to open the product’s packing. Pull the cable out of the spiral by pushing on the plug, then attach it to an instrument that is compatible with it.
Make that the nose has been turned to the locked position.
Once the wire has been zeroed, carefully take the guide wire out of the spiral and remove the connector body from the spiral clip. Standard tip-shaping procedures can now be used to shape the guide wire tip.
Put the guide wire through the proper introducer parts and guiding catheter into the intended blood vessel after wetting its working length with regular saline.
Under fluoroscopic guidance, slowly advance the tip of the guide wire, and use contrast injections to confirm its position.
Make that the wire’s proximal contact bands are not kinked. When applying torque, make sure there is no resistance and that the tip is turning freely.
Find the pressure sensor next to the guide catheter’s tip, then use the device to normalize it.
Move the sensor to the intended measurement spot, then use the device to take measurements.
Check that the pressures are equivalent after removing the pressure sensor.
For St Jude Medical system:
Place the pressure wire on the sterile field after using sterile techniques to open the product’s packaging. The gray connector should be connected to the RadiAnalyzer Xpress after being taken out of its holder.
Move the sensor element forward until it is barely outside the entrance of the guiding catheter. Make that the Pressure Wire and aortic pressures are equal at that location.
Place the aortic transducer at the patient’s heart level, take out the guide wire introducer needle, shut the valve firmly, flush away any remaining contrast, push Equalize, and hold for three seconds if the two pressures are not equal.
Await the achievement of steady baseline pressure readings. Use intracoronary adenosine (15–40 µg) or intravenous adenosine to induce maximal hyperemia. To end the recording, press Stop/View after the maximum hyperemia has been reached. The FFR is then automatically calculated by the device.
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Home » Procedure » Fractional Flow Reserve (FFR) Measurement
Fractional Flow Reserve (FFR) Measurement
Updated :
December 3, 2025
Finding the ratio between the maximum blood flow can be achieved in a diseased coronary artery and the maximum flow that may theoretically achieved in a normal coronary artery is the process of measuring fractional flow reserve (FFR).
Most people agree that an FFR of 1.0 is normal. Myocardial ischemia (MI) is typically linked to an FFR below 0.75 to 0.80.
Using a pressure wire to determine the ratio of coronary pressure distal with a coronary artery stenosis makes it simple to measure FFR during normal coronary angiography.
FFRs obtained from outflow boundary conditions based on conventional morphology largely accord with those based on positron-emission tomography (PET) conditions. The functional severity of coronary artery stenoses has been assessed using computed tomography (CT)-based FFR computations.
MI occur when myocardial blood supply is restricted by coronary artery stenosis. The cardiologist uses visual inspection during cardiac angiography to assess the degree of coronary artery stenosis.
If the luminal diameter narrows by 70% or more, the lesion is usually regarded as serious and flow-limiting.
To assess the hemodynamic and physiological relevance of coronary stenosis
To determine the relevant lesion or lesions that are the cause of multivessel coronary artery disease (CAD).
In the presence of distal collateral flow to determine the functional significance of stenosis.
In cases where the angiographic image is not clear to determine the exact location of a coronary lesion.
Known Allergy or Hypersensitivity to Adenosine
Severe Asthma or Reactive Airway Disease
Second or Third-Degree Atrioventricular (AV) Block Without a Pacemaker
Hypotension or Hemodynamic Instability
Severe Aortic Stenosis
Left Main Coronary Artery Disease
Severe Anemia
The purpose of the trial was to determine whether skilled interventional cardiologists could use coronary angiography to find individuals with FFRs less than 0.75.
The significance of most mild coronary lesions was not predicted by skilled interventional cardiologists’ angiographic evaluation of an angiography.
The Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) study examined the function of FFR in the assessment of multivessel CAD. The findings of the study indicated that patients with multivessel CAD benefit more from a revascularization approach that uses FFR.
Angiography-identified patients with multivessel CAD were randomized to receive FFR with angiography or angiography alone.
All angiographically serious lesions in the patients in the angiography-only arm were stented. Only patients whose FFR was 0.80 or below were stented in the FFR-plus-angiography arm.
Basic Cardiac Catheterization Equipment
FFR-Specific Equipment
Monitoring and Supportive Equipment
The cardiologist determines if FFR measurement is likely to be helpful following a diagnostic cardiac catheterization and the identification of a stenosis.
Prior to cardiac catheterization, patient should typically fast for four to six hours.
For at least 12 to 24 hours before, stay away from coffee since it may interfere with the hyperemia caused by adenosine.
Additional contrast use and radiation exposure are risks unique to the FFR operation, and there is a modest increase in the risk of coronary artery dissection with FFR wire passage.
Informed Consent:
The cardiologist should inform the patient of all the possible risks and advantages of the cardiac catheterization including the potential need for an unforeseen coronary intervention.
Information on stent installation and other invasive evaluation methods, such as fractional flow reserve (FFR) measurement should be discussed in relation to the intervention.
The patient is on the procedure table, lying flat. When placing an ECG lead or accessing an IV, the arms are often comfortably at the sides or extended on arm boards.
For Volcano systems:
Place the spiral on the sterile field after using sterile techniques to open the product’s packing. Pull the cable out of the spiral by pushing on the plug, then attach it to an instrument that is compatible with it.
Make that the nose has been turned to the locked position.
Once the wire has been zeroed, carefully take the guide wire out of the spiral and remove the connector body from the spiral clip. Standard tip-shaping procedures can now be used to shape the guide wire tip.
Put the guide wire through the proper introducer parts and guiding catheter into the intended blood vessel after wetting its working length with regular saline.
Under fluoroscopic guidance, slowly advance the tip of the guide wire, and use contrast injections to confirm its position.
Make that the wire’s proximal contact bands are not kinked. When applying torque, make sure there is no resistance and that the tip is turning freely.
Find the pressure sensor next to the guide catheter’s tip, then use the device to normalize it.
Move the sensor to the intended measurement spot, then use the device to take measurements.
Check that the pressures are equivalent after removing the pressure sensor.
For St Jude Medical system:
Place the pressure wire on the sterile field after using sterile techniques to open the product’s packaging. The gray connector should be connected to the RadiAnalyzer Xpress after being taken out of its holder.
Move the sensor element forward until it is barely outside the entrance of the guiding catheter. Make that the Pressure Wire and aortic pressures are equal at that location.
Place the aortic transducer at the patient’s heart level, take out the guide wire introducer needle, shut the valve firmly, flush away any remaining contrast, push Equalize, and hold for three seconds if the two pressures are not equal.
Await the achievement of steady baseline pressure readings. Use intracoronary adenosine (15–40 µg) or intravenous adenosine to induce maximal hyperemia. To end the recording, press Stop/View after the maximum hyperemia has been reached. The FFR is then automatically calculated by the device.
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