FFR for Borderline Blockages

In the field of interventional cardiology, accurately determining the significance of a coronary blockage is crucial for making informed treatment decisions. Some blockages may appear visually significant on angiography but may not cause significant blood flow restriction. Fractional Flow Reserve (FFR) is a diagnostic tool that provides precise measurements of blood flow across a coronary blockage. In this blog post, we will explore the concept of FFR and its significance in evaluating borderline blockages in cardiology.

Understanding FFR:

Fractional Flow Reserve (FFR) is a technique used to assess the functional significance of coronary artery stenosis, which refers to the narrowing or blockage of the blood vessels that supply the heart. FFR is measured by comparing the pressure upstream and downstream of a coronary artery blockage during maximal blood flow. It quantifies the pressure drop across the blockage and indicates the extent to which blood flow is compromised.

The FFR value represents the ratio of the pressure measured after the blockage (distal pressure) to the pressure measured before the blockage (proximal pressure). An FFR value of 1 indicates normal blood flow, while an FFR value less than 1 suggests a significant flow-limiting blockage.

Benefits of FFR for Borderline Blockages:

  • Precise Functional Assessment: Borderline blockages are challenging to evaluate based solely on visual assessment during angiography. FFR provides a functional assessment, helping interventional cardiologists determine whether a borderline blockage is truly causing significant blood flow restriction. This information guides treatment decisions, allowing clinicians to prioritize interventions based on the severity of the blockage
  • Improved Decision-making: By providing objective data on the functional significance of a blockage, FFR helps reduce unnecessary interventions. It helps identify lesions that may not require immediate intervention, allowing cardiologists to focus on lesions that are truly causing flow limitation and require treatment. This targeted approach optimizes patient care and conserves healthcare resources.
  • Enhanced Patient Outcomes: FFR-guided treatment strategies have been shown to improve patient outcomes. Studies have demonstrated that deferring intervention for non-flow-limiting lesions, as determined by FFR, results in comparable outcomes to immediate intervention. This approach minimizes the risks associated with unnecessary interventions while ensuring appropriate treatment for significant blockages.
  • Economic Benefits: FFR has been shown to be a cost-effective strategy for managing borderline blockages. By avoiding unnecessary interventions, healthcare costs are reduced, and resources can be allocated more efficiently. Additionally, FFR-guided interventions can lead to better long-term outcomes, reducing the need for repeat procedures and associated costs.

Considerations and Limitations:

While FFR is a valuable tool in evaluating borderline blockages, it is important to consider certain limitations:

  • Operator Experience: FFR measurements require technical expertise and proper technique to obtain accurate and reliable results. The proper placement of the pressure wire and interpretation of FFR values necessitate well-trained interventional cardiologists.
  • Limitations in Specific Cases: FFR measurements may not be suitable for all patients or lesions. Conditions such as microvascular dysfunction, diffuse disease, or heavily calcified vessels may affect the accuracy of FFR measurements. In such cases, additional assessments or alternative diagnostic techniques may be required.


Fractional Flow Reserve (FFR) provides a valuable tool for evaluating borderline blockages in interventional cardiology. By assessing the functional significance of a blockage, FFR enables cardiologists to make informed decisions about intervention, avoiding unnecessary procedures and optimizing patient care. FFR-guided treatment strategies improve patient outcomes, offer cost-effective solutions, and ensure the appropriate allocation of healthcare resources. As FFR technology continues to advance, it is poised to play an increasingly important role in the management of borderline blockages, contributing to better patient care and improved cardiovascular outcomes.