The vulnerability of fractional flow reserve.

摘要

Fractional flow reserve (FFR) expresses the maximal flow down a vessel in the presence of a stenosis compared to the maximal flow in the hypothetical absence of the stenosis. Since publication of the FAME-trial, measurement of FFR by the use of a pressure wire has been adopted by interventional cardiologists worldwide to assess the potential of coronary lesions to induce myocardial ischaemia. The FAME-trial compared a strategy of revascularization based on angiographic severity with an FFR-based approach, in which only haemodynamically significant lesions, as defined by an FFR-threshold below 0.80, were treated with stent implantation. This functional evaluation significantly reduced the primary end point of death, myocardial infarction (MI), or revascularization at one year, hereby underscoring the importance of functional over angiographic severity of a coronary lesion. Such an FFR-based strategy allows to virtually eliminate the so-called 'oculostenotic' reflex and unnecessary revascularizations. However, our case reminds us of 'enigmatic' coronary lesions of which the behaviour cannot be predicted by means of FFR: the vulnerable plaque.