Invasive functional assessment of moderate coronary artery stenoses, State of the art and a glimpse to the future

Physiological assessment of moderate coronary lesions is routine practice in the majority of cardiac catheterization laboratories. This is performed using dedicated devices (pressure wires or microcatheters) that allow the measurement of pressure derived physiological indices, for example fractional flow reserve (FFR). FFR has Class I indication with level of evidence A according to the most recent European Guidelines on myocardial revascularization for the assessment of angiographically moderate coronary lesions. In this review we aim to: 1) summarize the theoretical basis of the FFR; 2) provide an overview of vasodilators used for FFR evaluation; 3) summarize the scientific evidence supporting FFR; and 4) to provide insights into the introduction and application of iFR, as a further tool for physiologically assessment of moderate coronary stenoses. Key words: Myocardial Ischemia; Coronary Revascularization; Physiological Assessment of Coronary Lesion