Is Hyperaemia Essential for Accurate Functional Assessment of Coronary Stenosis Severity?

Fractional flow reserve (FFR) requires the use of maximal hyperaemia as described in the original preclinical and clinical validation studies and subsequent practice changing randomized controlled trials. A perception that the need for hyperaemia (usually induced with adenosine) was one of the obstacles to more widespread adoption of FFR has led to interest in the use of resting non-hyperaemic indices to assess the functional significance of coronary stenoses. We examine the current evidence base and conclude that resting indices agree with FFR in only 80 % of lesions when a binary cut-off is employed but closer to 90 % when hybrid strategies utilising both resting indices and FFR are utilised. It seems counter intuitive to sacrifice diagnostic accuracy when in most patients and healthcare systems the induction of hyperaemia with adenosine is safe and emminently affordable.
Competing Interests: Disclosure: Dr Hennigan has previously received speaker fees from Volcano Corporation. Dr Robertson has no conflicts of interest to declare. Professor Berry has undertaken consultancy work and given lectures based on institutional contracts between his employer, the University of Glasgow and St Jude Medical. St Jude Medical has also provided support for research with pressure wires. Prof Oldroyd has received speaker fees and institutional grant support from St Jude Medical and speakers fees from Volcano.