Comparison of wire-based hyperaemia-induced fractional flow reserve (FFR) and angiography-based vessel fractional flow reserve (vFFR) in patients undergoing physiological assessment of coronary lesions.

OBJECTIVE: While pressure-wire based fractional flow reserve (FFR) is considered the gold standard for evaluating coronary lesion significance, its use in daily clinical practice remains limited.Angiography derived vessel based FFR (vFFR) offers a promising alternative, without the need for pressure wires or hyperaemia by leveraging three dimensional quantitative coronary angiography. METHODS: This study evaluated the concordance between angiography derived vFFR and invasive FFR in patients with intermediate coronary stenosis. Retrospectively, coronary angiograms of patients who underwent adenosine based FFR from January 2022 until January 2025 for borderline lesions were retrieved from the health management information system (HMIS) software and processed by a blinded core laboratory for vFFR computation. Correlation and diagnostic performance were assessed using Mann-Whitney U testing, Spearman correlation, Bland-Altman analysis, chi-square analysis, ROC curves, and binary logistic regression. RESULTS: The median age of the cohort was 61 years, and 30.6% were female. LAD was the most commonly assessed artery. The median FFR and vFFR values were 0.85 and 0.83, respectively. Overall, 33.9% of lesions were classified as ischemic by FFR. A strong correlation was found between vFFR and invasive FFR (r = 0.808, p < 0.001). The diagnostic performance of vFFR was excellent with an AUC of 0.92. At a vFFR cut off of 0.80, sensitivity was 85.7% and specificity 80.5% with a diagnostic accuracy of 82.3%. Subgroup analysis demonstrated reduced correlations in bifurcation (r=0.661) and calcified lesions (r=0.733). CONCLUSIONS: In this retrospective cohort, angiography derived vFFR demonstrated good correlation and diagnostic performance compared with invasive FFR for the assessment of intermediate coronary lesions.