Times of India
11 August 2010
By Malathy Iyer
Mumbai, India

The pain in 76–year–old P Naidu’s chest had been worrying his family for weeks. The Andheri–based Naidu family (name changed) had been primed by their general practitioner to expect an expensive angioplasty, with one or two stents. But, to their pleasant surprise, the cardiologists who mapped their father’s heart were confident that he needed only daily medication.

What made the doctors so sure that he didn’t need an operation? According to Naidu’s cardiologist Dr Ashwin Mehta, director at Jaslok Hospital’s cardiology department, "It was the use of the fractional flow reserve (FFR) measurement system along with angiography that helped us decide that the blockages in Naidu’s arteries didn’t need an angioplasty or surgery.’’ In the process, the Naidus also saved money, as each medicated stent can cost between Rs 70,000 and Rs 1.2 lakh.

The number of angioplasties–a minimally invasive way to clear heart blockages–has been on the rise in the last few years, generating concern that not all such surgeries are absolutely essential, especially since stents are expensive.

Of the many tools to detect heart problems, the angiogram (a sort of X–ray of the blood vessels or the heart’s chambers) is most commonly used. Now, there is the FFR, relatively new for Mumbai (though major hospitals in Delhi bought it over six months ago).Jaslok Hospital,Pedder Road,acquired the FFR ensemble three months ago, and Jupiter Hospital, Thane, bought it recently. Other city hospitals will likely follow suit.

City Hospitals Have It

• An angiogram, the most commonly used diagnostic tool used to detect heart problems, offers a subjective but in most cases accurate assessment of the problem
• The fractional flow reserve measurement system, a relatively new technique, provides a detailed physiological analysis of blockages in the heart–apt for rare cases where a patient’s blockages (or their extent) are difficult to diagnose using other methods
• Jaslok and Jupiter hospitals in the city have already acquired FFR ensembles

FFR diagnosis apt for difficult cardiac cases
Mumbai: The fractional flow reserve (FFR) measurement system, a relatively new cardiac diagnostic tool in the city, provides a detailed physiological analysis of blood–flow blockages in a patient’s heart. "In most cases, it is easy for the cardiologist to decide whether the patient needs a stent by using an angiogram. The assessment is subjective; it is mainly an eyeballing exercise, but is accurate in most patients,’’ said Mehta.

However, there is a percentage of patients in whom it is not an easy call to decide if a stent is needed. "With the introduction of drug–eluting stents, the percentage of patients with multi–vessel coronary artery disease undergoing angioplasty and stenting is going up. Using an FFR, we can cut down on the need for unnecessary stenting,’’ said Dr Vijay Surase, interventional cardiologist with Jupiter Hospital.

Surase used FFR on July 31 to decide whether his patient, 65–year–old Madhukar Chaudhary, who had recurrent heart problems, needed two stents. An angiography revealed 100% occlusion in one of the arteries and borderline disease in another. "It was with FFR that we realised that the disease was so significant in the other artery that it needed stenting,’’ he added.

However, the FFR method should not be used for all patients. According to Dr Prafulla Kerkar, head of the cardiology department of civicrun KEM Hospital, "It is meant for those once–in–ablue–moon patients whose blockages (or their extent) are difficult to diagnose using other methods.’’