Znaczenie pomiaru cząstkowej rezerwy przepływu wieńcowego (FFR) a iFR — czy potrzebujemy nowej techniki do oceny istotności zwężenia naczyń wieńcowych?

Fractional flow reserve (FFR) is a technique, which allows the accurate assessment of stenosis severity and can be easily and quickly measured during coronary angiography. For past years, FFR has been a basic tool in interventional cardiology, allowing to assess the potential benefit of revascularisation of coronary artery disease. Instantaneous wave-free ratio (iFR) is a recently developed, helpful physiological index, used to evaluate the severity of stenosis, calculated by measuring the resting pressure gradient across a coronary lesion during the portion of diastole. During the American College of Cardiology 2017 Scientific Session in Washington, the outcomes of two large, randomised trials were presented: iFR-SWEDEHEART and DEFINE-FLAIR, comparing iFR vs FFR with a combined total of 4,500 patients. The outcomes show, that iFR is non-inferior to FFR, with similar rates of major adverse cardiac events. We have to wait for the results from further randomised studies, comparing FFR with iFR and long-term follow-up of patients, who were assigned to undergo evaluation of stenosis severity.