The Impact of Objective Mathematical Analysis During Fractional Flow Reserve Measurement. Results from the OMA-FFR Study

AIMS: Fractional flow reserve (FFR), the reference-standard for guiding coronary revascularisation, is most commonly acquired during intravenous adenosine infusion. Results may be sensitive to system- and operator-dependent variability in how pressure data are analysed and interpreted. We developed a computational protocol to process the recorded pressure signals in a consistent manner to objectively quantify FFR. We studied the impact upon lesion (re)classification and compared this with the operator-selected FFR obtained during cardiac catheterisation. METHODS AND RESULTS: The algorithm used a moving average and Fourier transformation to identify the Pd/Pa ratio at its nadir (FFRmin) and during the stable hyperaemic period (FFRstable) in <2s with 100% repeatability, in 163 coronary stenoses (93 patients). The mean operator-selected FFR (FFRCL) was higher than FFRmin and lower than FFRstable (0.779 vs 0.762 vs 0.806, P=<0.01). Compared with FFRmin, FFRstable resulted in 16.5% of all lesions being re-classified, all from significant to non-significant (p<0.01). FFRCL classified lesion significance differently to both FFRstable and FFRmin (11.7% and 6.1% lesions reclassified respectively, p