Do you suspect you have heart disease? Or has your doctor mentioned a blockage in your coronary arteries? You may have heard of this test called Fractional Flow Reserve, or FFR for short. Although it may sound like a complicated name, it is a very important test. So, let's talk about it today in simple, understandable Sinhala.
What is Fractional Flow Reserve (FFR)?
Simply put, (FFR) is a method of measuring exactly how severe the stenosis is, that is, how much it hinders blood flow, if there is a blockage somewhere in the coronary arteries that supply blood to your heart. Imagine that when a water pipe is blocked, the speed and pressure of the water decreases, right? In the same way, when a coronary artery is blocked, the pressure of the blood flowing through it decreases. What this (FFR) test does is measure that pressure difference and find out exactly how much the blockage is.
Doctors usually do this (FFR) test during a cardiac catheterization or coronary angiogram. The results of this test help determine what kind of treatment you should receive (for example, whether you should have medication alone or angioplasty and a stent). This is a very important test that can help you make important decisions.
When is an FFR test needed?
Not everyone will need to have this test. A doctor will decide to do this (FFR) test in a few special cases.
- If imaging of your coronary arteries shows that between 50% and 70% of the diameter of the artery is blocked (stenosis), this (FFR) test can tell exactly how much that blockage is actually obstructing blood flow.
- Sometimes, even if there is a significant blockage of about 90% of the artery, this test is performed to accurately assess its severity.
However, if your artery blockage is less than 30% or much more than 70%, this (FFR) test is usually not necessary. Because if the blockage is very small (less than 30%) then treatment (like angioplasty) is unlikely to be necessary. If the blockage is very large (more than 70%), treatment is definitely needed. What the (FFR) does is help make the right decision in those in-between situations.
Important: If you have previously had angioplasty and a stent placed in your artery, this (FFR) test can also help predict the likelihood of a major heart attack in the future.
Are there any disadvantages to this (FFR) test?
Like every medical test, there are small things to consider.
- Sometimes, a false normal result can occur. This means that there is actually a problem, but the test may not detect it. One reason this can happen is if your very small blood vessels (coronary arterioles) do not respond properly to the medication given during the test to widen your blood vessels.
- Also, the length of the narrowed area in the vein also affects the FFR value.
Since your doctor knows all of these things well, he or she will make decisions after considering all of these things.
What is (iFR) and (FFR)? What is the difference between the two?
You may have heard of something called (iFR). (iFR) stands for (instant wave-free ratio). Both (FFR) and (iFR) are tests that measure how severe the blockage is in the arteries of the heart. But there is a slight difference.
- During the (FFR) test: A special drug, such as adenosine (Adenocard® or Adenoscan®), is given to dilate the blood vessels as much as possible and increase blood flow.
- In the (iFR) test: Without using a drug like that, the pressure is measured at a specific moment in the heart's cycle.
Although the goal of both is the same, there are slight differences in the way they are performed. Your doctor will decide which is best for you.
Who performs the (FFR) test?
This is a specialist medical test. The (FFR) test is performed by a cardiologist , who has special training for this.
How does the (FFR) test work?
This may seem like a simple procedure, but it involves a somewhat complex technique. The blood pressure is measured both distal to the blockage in your coronary artery and proximal to it . That is, the pressure is measured before and after the blockage. The ratio between these two pressure values is called the fractional fraction (FFR). This is what gives us an idea of how much blood flow is obstructed.
How should I prepare for the (FFR) test?
This is like preparing for a minor surgery. Your doctor will explain this to you in detail, but generally, you will need to do the following:
- Your doctor may ask you to stop taking certain medications, especially blood thinners , a few days before the test.
- Do not eat or drink anything after midnight the night before the test (NPO - nothing by mouth).
- Because you will be given anesthesia or a mild sedative during this test, you will need someone to drive you home after the test. You will not be able to drive yourself.
What to expect on the day of the (FFR) test?
The test itself usually takes less than an hour . However, if the doctor checks your FFR on the spot and decides to perform an angioplasty or stent, it will take additional time. Therefore, it is a good idea to ask your doctor in advance how long you will need to stay in the hospital, including time to prepare and rest after the test.
What happens during the (FFR) test?
Okay, now let's see what happens inside the test. Although these steps may seem a little complicated, the medical team will take good care of you.
1. Numbness: First, a small area of your skin (on your arm, neck, or groin) is numbed with a local anesthetic.
2. Inserting the needle: Next, a small needle is inserted into a vein through the puncture site.
3. Catheter insertion: Through this incision, a very thin, long tube-like device (catheter) is passed through your blood vessels to the coronary arteries of your heart.
4. Viewing the path: A special (X-ray)-like method called fluoroscopy is used to check on a screen to see if the catheter is going in the right place.
5. Contrast fluid: Next, a special dye (contrast media) is injected through this catheter into the veins of your heart. The veins then show up clearly on an X-ray.
6. Blockage test: This is used to check if there are any blockages anywhere in the arteries of your heart.
7. Viewing blood flow: Sometimes, a small ultrasound device attached to the end of this catheter can be used to view the blood flow inside the blood vessels.
8. Administering medication: Before a pressure wire is inserted into the blocked area, medications such as heparin (to prevent blood clotting) and nitroglycerin (to dilate the blood vessels) (Nitronal® or Tridil®) are administered.
9. Measuring pressure: Now comes the real work. A special wire (pressure wire) is passed through the blocked area, and the sensors on it measure the blood pressure before and after the vein is blocked. To measure this accurately, the blood flow is measured at the time of maximum blood flow. For that, a drug (adenosine) or (papaverine) is given to temporarily increase your blood flow.
10. Treatment (if necessary): If the blockage is considered severe based on the FFR value, angioplasty (widening the artery with a balloon) may be performed on the spot, and a stent (a small tube like a mesh) may be placed to prevent further blockage.
11. Re-testing: After the stent is placed, the FFR value is checked again to confirm whether the treatment was successful.
12. Finishing: Finally, the catheter and wire are removed, the puncture site is held in place for a while, and then a plaster is applied.
What to expect after the (FFR) test?
Most people do not experience any significant discomfort after this (FFR) test, and complications are very rare.
- If you only have the test done, you can usually go home in a few hours.
- However, if you have angioplasty and a stent placed after FFR, you may have to stay in the hospital that night under medical supervision.
What are the side effects of the (FFR) test?
As with every medical procedure, some people may feel minor discomfort.
- You may experience chest pain or shortness of breath for about a minute after you are given the adenosine (either by IV or directly into the heart). This is normal and should not be alarmed. This means that your blood flow is at its peak, which means it is time to measure your FFR. This discomfort will go away quickly.
- (Papaverine) can very rarely (about 1% of people) cause an abnormal heart rhythm , but this usually resolves after a while.
- It is important to remember that since this (FFR) test is performed with a cardiac catheterization, there are some risks associated with it (e.g. bleeding, infection, allergy to the contrast medium). However, these are very rare.
How is the (FFR) value calculated?
This is like a mathematical formula. The doctor divides the pressure in your coronary artery distal to the blockage (Pd) by the pressure in your coronary artery proximal to the blockage (Pa).
Simply put, FFR = Pd / Pa .
These pressure measurements are taken by the doctor using special equipment during cardiac catheterization.
What are the results like? What do they tell us?
You will get a number with decimal places.
- A normal FFR value is between 0.94 and 1.0. If this value is reached, it means that there is no significant obstruction to the flow of blood through the veins.
- If the FFR value is generally less than 0.80, it means that the blockage is causing significant obstruction to blood flow, and therefore treatment (often angioplasty and stenting) is needed.
- For example, if your FFR is 0.75, it means that your blood pressure has decreased by 25% due to the narrowing of your coronary arteries (1.00 - 0.75 = 0.25, or 25%).
- If the FFR value shows that the blockage is not that severe, then angioplasty and stenting are not necessary. It can be treated with medication alone. This can help avoid unnecessary surgery.
When will I know the results of the (FFR) test?
This is the best thing. The doctor will show you the FFR values on his device as soon as he takes your blood pressure readings. So, either during the test or after it's over, the doctor will tell you the results and what to do next.
When should you talk to the doctor? (After the examination)
When you go home after the test, you should immediately notify your doctor or the nearest hospital if you have one or more of these symptoms:
- Chest pain (especially pain that is new, severe, or doesn't go away with rest)
- Difficulty breathing
- Fever (elevated body temperature)
- Pain, swelling, redness, or pus at the access site
- Feeling dizzy or faint
- Abnormal heartbeat or palpitations
Don't ignore these symptoms.
Finally, remember
This (Fractional Flow Reserve - FFR) test is a modern and accurate method that helps your doctor decide the best treatment for your coronary artery disease. The medical staff will make sure you are as comfortable as possible during the test. If there is anything you do not understand or if you are worried, be sure to ask the doctor or nurse. It is your right.
It's good to be mentally prepared for that, as you may need to have an angioplasty or stent placed right after checking your FFR. Remember, everything is done to protect your heart's health.
Wishing you a speedy recovery!
` Heart disease, coronary artery disease, FFR test, Fractional Flow Reserve, cardiac catheterization, coronary angiogram, angioplasty, stent, heart attack, heart disease symptoms
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