FFR: pitfalls · Aminian A et al. CCI 2015 BL FFR eng. FFR diseng. 1.00 0.80 0.50 Slight reduction...

9th Coronary Physiology in the CathLab Course, Nice 2015

FFR: pitfalls

Emanuele Barbato

Cardiovascular Centre Aalst, Belgium

Federico II University Naples, Italy

Pitfalls can be related to.... Preparation

• Calibration

• Equalization

Measurement

• Drifting

• Hyperaemia

• Wedging

• Whipping

Tracing interpretation

• Cursor position

• Calibration

• Equalization

Measurement

• Drifting

• Hyperaemia

• Wedging

• Whipping

• Cursor position

Calibration

‘teaching’ the system, what is zero pressure

Setting in the cathlab

• Aortic pressure is measured by the fluid filled

guiding catheter

• Its value is a relative pressure, compared to

the reference, measured at the transducer

• Height of the transducer has a measurable

impact on the value

Calibration: Position of the Transducer

Pressure TOO LOW

Pressure TOO HIGH

Pressure OK

Calibration: PressureWire

• Fill the tube of the wire with saline

• Wait a minute to have the system stabilized

• Perform calibration afterwards

Equalization

‘teaching’ the two systems, to speak the same language

Pa Pd =

Equalization

After equalization DO NOT CHANGE YOUR SETTING

• Calibration

• Equalization

Measurement

• Drifting

• Hyperaemia

• Wedging

• Whipping

• Cursor position

• Calibration

• Equalization

Measurement

• Drifting

• Hyperaemia

• Wedging

• Whipping

• Cursor position

Drifting

When the two systems forget to speak the

same language ...

Pa Pd ≠

Post-measurement check

= Drift!!!

Drift Same morphology

Paralell shifting

Dicrotic notch well visible

True Gradient Different morphology

Dicrotic notch not visible

Drift vs Gradient ??

Hyperaemia

No hyperaemia …? … no FFR!

Wedging

Aortic pressure is inaccurately measured...

4 mm 2.4 mm 36 %

4 mm 2.1 mm 27 %

4 mm 1.8 mm 20 %

Induced area stenosis

Size of the guiding catheter

3 mm 2.4 mm 64 %

3 mm 2.1 mm 49 %

3 mm 1.8 mm 36 %

Size of the guiding catheter Induced

area stenosis

Wedging guiding catheter

Disengaged guiding catheter

Wedging guiding catheter

FALSE 0.88 TRUE FFR 0.66

Functional wedging of guiding catheter

Aminian A et al. CCI 2015

BL FFR eng. FFR diseng.

Slight reduction in hyperemic Pd/Pa at disengangement that with values close to the

threshold resulted into transition of 0.80 in 30% of the cases

Whipping

• Calibration

• Equalization

Measurement

• Drifting

• Hyperaemia

• Wedging

• Whipping

• Cursor position

• Calibration

• Equalization

Measurement

• Drifting

• Hyperaemia

• Wedging

• Whipping

• Cursor position

Position the cursor to the lowest value where indeed FFR was measured

Fractional flow reserve measurement

Induce proper maximal hyperaemia

Reading the pressure tracings appropriately

Obtain accurate measurements

Thank you for your attention!

Credit for the slides to Dr. Gabor Toth and Nico Pijls

Fractional flow reserve measurement

Accurate distal coronary pressure (Pd)

Accurate aortic pressure (Pa)

Maximal hyperaemia

Drift vs Gradient ??

• Curves are identical in shape

• Curves are shifted paralell

• Dicrotic notch is well visible on both

Insufficient hyperaemia

Underestimation of

the gradient

Overestimation of

the FFR

Underestimation of

disease

Pressure TOO LOW

Pressure TOO HIGH

Pressure OK

Setting in the cathlab

FFR: pitfalls · Aminian A et al. CCI 2015 BL FFR eng. FFR diseng. 1.00 0.80 0.50 Slight reduction...

Documents

(±ñfr 3. FFr · (±ñfr 3. FFr . Created Date: 7/14/2011 4:23:42 PM

FFR Support Services Connections

FFR Notification

FOUNDATIONS OF FINANCIAL RISK (FFR) Exam Preparatory · PDF fileFOUNDATIONS OF FINANCIAL RISK (FFR) ... English & Business Communication, ... Foundations of Financial Risk (FFR)exam

Ffr chap08

FFR Catering and Conference Centers

Interface TG ZDR-FFR

Ffr chap09

INSTRUCTION MANUAL MAINTENANCE TROUBLE ... - G&G …-document... · FFR 16 FFR 17 FFR 18 FFR 19 FFR 20 FFR 21 FFR 22 FFR 23 FFR 24 FFR 25 FFR 26 FFR 01 FFR 02 FFR 03 FFR 04 FFR 05

FFR The Basics

FFR: pitfalls · ETP course 2014, Sophia-Antipolis FFR: pitfalls . Equalization ETP course 2014, Sophia-Antipolis FFR: pitfalls ‘teaching’ the two systems, to be synchronous ETP

PressureWire - Incathlab€¦ · True FFR Ð The Most Reliable FFR System on the Market The FAME trial, which demonstrated that accurate FFR measurement is crucial to improve patient

Chem 213 FFR 4

Ffr chap21

FFR Club Training S11

Ffr chap25

Ffr guided coronarY intervention

Ffr chap15

Too much Hop-up. ( Turn the adjustment lever …...FFR 12” SD FFR 9” FFR 15 FFR 16 FFR 17 FFR 18 FFR 19 FFR 20 FFR 21 FFR 22 FFR 23 FFR 24 FFR 25 FFR 26 FFR 01 FFR 02 FFR 03 FFR

FFR 3-Link Installation Guidecajungenie.com/Wedding/FFR/HelpfulRef/3-Link Instructions... · 2013. 9. 13. · Racing (FFR) Competition 3 Link Suspension. This guide is based on the