Advancing Coronary Physiology Assessment: Software-Based FFRangio as an Alternative to Pressure-Wire FFR
by Micaela Harris-Kim
March 30, 2026
Individuals experiencing coronary stenosis, or coronary artery disease, experience a buildup of plaque in the heart’s arteries, which prevents blood flow, leading to cardiovascular problems. The main technique for diagnosing the severity of this build up involves using an intracoronary pressure wire during cardiac catheterization and percutaneous coronary intervention, a procedure in which clinicians insert a thin catheter into a blood vessel and guide it to the heart to image the coronary arteries and assess blood flow. However, clinical use of placing a pressure-sensing wire inside the coronary artery and administering medication to increase blood flow in order to measure an index called fractional flow reserve (FFR) is quite low. This process adds time and potential risk to the procedure and, although it is recommended in clinical guidelines, it remains significantly underutilized in clinical practice. Recently, a new technique for estimating FFR based on the coronary angiographic images and computer software without the need of a pressure wire has been developed and called FFRangio.
(Image generated using an LLM)
A study recently published in New England Journal of Medicine, co-PI and first author of the study, William Fearon, MD and co-author Rahul Sharma, MBBS, FRACP led a study examining the ALL-RISE trial, a multicenter, noninferiority trial conducted at 59 sites across the world – including North America, Europe, Japan and Israel, where 1930 randomized patients received either the FFRangio-guided treatment, the software-based analysis of coronary angiography images or the pressure wire-guided treatment.
The investigators found that using FFRangio based only on images from coronary angiography worked similarly to the standard pressure-wire method when looking at major outcomes after one year, including death, heart attack, or follow up procedures. Using FFRangio also proved to be more efficient compared to the pressure-wire method by shortening the procedure time, reducing radiation exposure, and requiring less contrast dye. Though, FFRangio identified more artery narrowing which led to more patients receiving stent placements. This may be because some blockages were close to the threshold where doctors decide whether or not to place a stent, and prior studies have shown patients in this range often do equally well whether the blockage is treated or monitored.
This study highlights the potential clinical use of FFRangio and how it performs similarly to the traditional wire-based method, supporting its use as an effective clinical tool, while being a more advantageous means in clinical settings by reducing procedure time, reducing radiation exposure, and requiring less contrast dye for patients.
William Fearon, MD
Rahul Sharma, MBBS, FRACP