Paul Morris is a senior clinical lecturer and interventional cardiologist, while Hazel Haley is a consultant interventional cardiologist, both hailing from Sheffield. They delve into the innovative world of virtual fractional flow reserve (VFFR) and its clinical implications. Insights from their VIRTU-4 study reveal how VFFR impacts patient management in coronary syndromes, shifting strategies towards enhanced therapies and PCI. They also discuss the limitations of VFFR and the importance of ongoing research in advancing non-invasive assessment tools in cardiology.
Virtual fractional flow reserve (VFFR) offers a less invasive method for evaluating coronary artery blood flow, improving patient management in cardiology.
The VIRTU-4 study demonstrated VFFR's significant impact on treatment strategies, prompting changes in management for 22% of patients evaluated.
Deep dives
Understanding Virtual Fractional Flow Reserve
Virtual fractional flow reserve (VFFR) is an innovative imaging-based approach that evaluates blood flow through coronary arteries without the need for invasive procedures. It utilizes two angiographic images to create a 3D reconstruction of the artery, where computational fluid dynamics simulations calculate pressure changes. Unlike traditional fractional flow reserve (FFR), VFFR avoids the insertion of pressure-sensitive wires and induction of hyperemia, making it less invasive. This ease of use overcomes many limitations associated with invasive methods, streamlining the process for interventional cardiologists.
Key Findings from the Virtue 4 Study
The Virtue 4 study involved 320 patients and aimed to assess how VFFR influenced management decisions during coronary angiography. Results showed that VFFR prompted a change in treatment strategies for 22% of the patients, highlighting its real-world applicability. Particularly notable outcomes included a 62% increase in optimized medical therapy in acute coronary syndrome (ACS) patients and a 31% increase in percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome (CCS). These findings underscore VFFR’s potential to enhance treatment decisions based on physiological assessments.
Implications and Future of VFFR in Clinical Practice
The study positions virtual FFR as a promising tool for improving patient management and decision-making in interventional cardiology. However, the current data is primarily hypothetical, and larger outcome studies are needed to validate the clinical benefits fully. Although VFFR shows potential to integrate anatomical and physiological evaluations, there remains a caution regarding operator experience affecting outcomes. As the field evolves, it’s conceivable that non-invasive techniques might reduce reliance on traditional invasive angiography, thus changing the landscape of coronary assessment.
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Prof. Paul Morris and Dr. Hazel Hayley from Sheffield, UK. They discuss the use of angiography-derived FFR and the results of their VIRTU-4 study pf that technology. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 or wherever you get your podcasts - it's really helpful.