Invasive fractional flow reserve: Which technology is best?

Invasive pressure measurements using hyperemic fractional flow reserve (FFR) and nonhyperemic pressure measurements (NHPR) are superior to angiography alone for assessment of 50-90% stenoses. FFR devices using piezoelectric and optical sensors achieve 94% concordance in FFR values; microcatheter designs have more lesion-crossing failures and less pressure drift compared with guidewire designs. Despite the similarity in statistical performance among FFR devices, interventional cardiologists may prefer to use NHPR to avoid the need for adenosine-related side effects, variations in vasodilator response, and limited application in patients with certain clinical and anatomic features.