Fractional flow reserve at 2013: an update.

: Fractional flow reserve (FFR) has become an extremely valuable tool for assessing the hemodynamic significance of intermediate coronary lesions in patients with stable coronary syndromes. This manuscript delineates the current data supporting FFR use to guide cardiovascular interventions in comparison to other invasive and non-invasive modalities. The correlation between FFR, symptom severity and likelihood of future major cardiovascular events are critically examined in view of the FAME-2 study results. The authors delineate the scientific gaps, potential pitfalls and misconceptions related to FFR with regards to current and emerging indications. Described are the most important developments related to FFR in 2012: instantaneous wave free ratio and non-invasive CT angiography based FFR. The manuscript proposes areas of future research to enhance the scientific data supporting current FFR clinical algorithms and strategies.