The Present and Future
State-of-the-Art Review
Invasive FFR and Noninvasive CFR in the Evaluation of Ischemia: What Is the Future?

https://doi.org/10.1016/j.jacc.2016.03.584Get rights and content
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Abstract

This review provides an integrative and forward-looking perspective on the gamut of coronary physiology for the diagnosis and management of atherosclerosis. Because clinical events serve as the ultimate gold standard, the future of all diagnostic tests, including invasive fractional flow reserve and noninvasive coronary flow reserve, depends on their ability to improve patient outcomes. Given the prominent role of acute coronary syndromes and invasive procedures in cardiology, we practically consider 2 broad categories of patients with coronary disease: acute and stable. For patients with acute coronary disease, coronary physiology may potentially refine treatment of the culprit lesion. For both patients with stable and acute nonculprit disease, reducing hard endpoints with revascularization potentially occurs at the severe end of the focal physiological spectrum, an area under-represented in existing trials. Nonepicardial disease and diffuse atherosclerosis remain underexplored aspects of coronary physiology for testing of novel treatments.

Key Words

coronary flow reserve
coronary physiology
fractional flow reserve

Abbreviations and Acronyms

ACS
acute coronary syndrome
CABG
coronary artery bypass graft
CAD
coronary artery disease
CFR
coronary flow reserve
FFR
fractional flow reserve
HMR
hyperemic microvascular resistance
IMR
index of microcirculatory resistance
MI
myocardial infarction
PCI
percutaneous coronary intervention
PET
positron emission tomography

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Dr. Johnson has received internal funding from the Weatherhead PET Center for Preventing and Reversing Atherosclerosis; and has received significant institutional research support from St. Jude Medical (for clinical trial NCT02184117) and Volcano/Philips Corporation (for clinical trial NCT02328820), makers of intracoronary pressure and flow sensors. Dr. Gould has received internal funding from the Weatherhead PET Center for Preventing and Reversing Atherosclerosis; and is the 510(k) applicant for CFR Quant (K113754) and HeartSee (K143664), software packages for cardiac positron emission tomography image processing and analysis, including absolute flow quantification. Dr. Di Carli receives research grant support from Gilead Sciences. Dr. Taqueti is supported by a Harvard Catalyst Medical Research Investigator Training award from the Harvard Clinical and Translational Science Center.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.

© 2016 by the American College of Cardiology Foundation. Published by Elsevier.