Invasive physiological assessment of the coronary circulation has emerged in recent years as a valuable diagnostic approach in the management of patients with chronic coronary syndrome, overcoming important limitations such as evaluating function from the anatomy and the low spatial resolution associated with angiography or non-invasive tests. The value of hyperemic flow measurements to estimate the functional relevance of coronary stenoses is supported by many studies. The aim of this paper is to review the physiological bases, clinical applications and limitations of mycardial fractional flow reserve, the main index used in the invasive functional assessment of the coronary circulation.
Fractional flow reserve: physiological bases, clinical applications and limitations
Sant’Anna,Fernando Mendes and Bandeira,Daniel Gustavo Sabino Ferreira and Sant’Anna,Lucas Bonacossa and Casagrande,Bruno and Maia,Júlio de Paiva and Caixeta,Adriano and Zukowski,Cleverson Neves and Chamié,Daniel. Fractional flow reserve: physiological bases, clinical applications and limitations. J Transcat Intervent [online]. 2022, vol.30, [cited 2026-04-24], Available from: <https://jotci.org/article/fractional-flow-reserve-physiological-bases-clinical-applications-and-limitations/>. ISSN . .
Sant’Anna,Fernando Mendes; Bandeira,Daniel Gustavo Sabino Ferreira; Sant’Anna,Lucas Bonacossa; Casagrande,Bruno; Maia,Júlio de Paiva; Caixeta,Adriano; Zukowski,Cleverson Neves; Chamié,Daniel. Fractional flow reserve: physiological bases, clinical applications and limitations. J Transcat Intervent, v.30, Jan. 2022. Available from: <https://jotci.org/article/fractional-flow-reserve-physiological-bases-clinical-applications-and-limitations/>. acess on 24 Apr. 2026. .
Sant’AnnaFernando Mendes, BandeiraDaniel Gustavo Sabino Ferreira, Sant’AnnaLucas Bonacossa, CasagrandeBruno, MaiaJúlio de Paiva, CaixetaAdriano, ZukowskiCleverson Neves, ChamiéDaniel. Fractional flow reserve: physiological bases, clinical applications and limitations. J Transcat Intervent [Internet]. 2022 Jan [cited 2026 Apr 24]; 30: Available from: https://jotci.org/article/fractional-flow-reserve-physiological-bases-clinical-applications-and-limitations/. .
Figure 1
P: pressure; Q: flow; R: resistance; Q stenosis : flow in the coronary artery with stenosis; Q normal : flow in the coronary artery in the absence of stenosis; P d : mean distal pressure in the coronary artery; P A : mean pressure in the aorta; R myo : myocardial resistance. Basis of fractional flow reserve calculation. Myocardial fractional flow reserve is calculated by dividing the mean distal coronary artery pressure by the mean aortic pressure during maximal hyperemia.