Cardiovascular disease (CVD) is a worldwide health problem, with it becoming the leading cause of mortality in India. The Global Burden of Disease study estimates the age-standardized CVD death rate to be 272 per 100,000 population in India, which is higher than the global average of 235 per 100,000 population. However, during the last several years, there have been some truly significant advances in heart disease treatment that are now moving quickly towards widespread patient accessibility. Moreover, there is a wave of transformation in the outlook of patients, who are more involved and more aware of the latest technological advances that can benefit their conditions. Globally, the advent of advanced technologies has brought revolutionary changes in the way patients are diagnosed, treated and involved in the treatment process, particularly in the field of cardiology.
There is a need to highlight the relevance of advanced technologies like Fractional Flow Reserve (FFR) for improving precision in blood flow assessment and heart blockage assessment. Normally, the decision to stent is taken once a physician sees the results of confirmatory diagnostic tests along with a view of the angiogram. Angiography is still considered the gold standard to visualise the blockages. However, it does not provide physiological/functional information as it is a visual technique and is prone to errors in judgement. FFR gives the physiological information by measuring the blood pressure difference across a blockage which helps to assess if the blood flow is adequate or not.
FFR uses a calibrated micro-sensor technology to find whether a cardiac patient really needs a stent or bypass surgery or can he be treated through medication. It helps by measuring the volume of the blood flow before and after the blockage area in the artery. If the pressure measurement is below 0.8, it means that the heart is not receiving enough blood flow. But, if the pressure ratio is above 0.8 (due to collateral branches etc.) the flow is adequate and the patient can be safely managed with medical therapy. With FFR, doctors can improve patient outcomes by identifying the culprit blockages and stenting only those which really require an intervention.
This technology primarily helps in quantitatively assessing and perfecting the treatment decision for the patient and recommending whether an intervention will or won’t have a significant impact. Being able to better select significant blockages; not only saves health care costs, but contributes to improved long-term clinical outcomes for the patients. FFR has been proven to improve treatment decision-making and procedural efficiency which ultimately benefits the patients in the long run. As per European Society for Cardiology (ESC) guidelines, FFR has been classified as Class 1 level of evidence A and American College of Cardiology (ACC/AHA) has provided a level of evidence A to the use of FFR technology.
Both of these are the highest level of evidence that a medical technology can receive towards patient benefit. It is, thus, clear that FFR is one of the most validated and precise tools for lesion assessment. FFR, as an emerging technology, offers insights into the evaluation of coronary blockages. By providing functional information of the severity of the blockage, it increases the specificity of the treatment. In addition to more accurate diagnosis, it helps in reducing healthcare costs by eliminating the need of unnecessary treatments. All these factors are making an impact on the way cardiology treatment is offered and the increased use of this tool has the potential to have an effect on the overall healthcare system.
By MS Hiremath
President, Cardiological Society of India