FFR Test in Hyderabad — Fractional Flow Reserve at AIG Hospitals, Gachibowli

When is the FFR test used in Hyderabad?

Dr. Bhishma Chowdary at AIG Hospitals, Gachibowli routinely uses FFR (or its equivalents) in the following clinical situations:

Intermediate coronary lesions — 40% to 70% stenosis

The most common and most important indication. When angiography shows a blockage in the 40 to 70% range — neither clearly insignificant nor clearly severe — FFR definitively answers whether it is causing ischaemia. Without FFR, many of these lesions are either stented unnecessarily or undertreated.

Multivessel coronary artery disease

When multiple blockages are found on angiogram, FFR is used to identify which specific lesions are haemodynamically significant and need stenting, and which can be safely managed with medication. This prevents unnecessary multi-vessel stenting — reducing procedure time, contrast dose, medication duration, and risk — while ensuring complete functional revascularisation of the lesions that truly matter.

Left main coronary artery disease

Left main stenosis carries high stakes — the left main supplies the majority of the heart's blood. Determining whether a borderline left main stenosis requires stenting or surgery is one of the most consequential decisions in interventional cardiology. FFR provides objective haemodynamic evidence that removes ambiguity from this critical decision.

After coronary bypass surgery

In patients with prior bypass surgery, native coronary arteries and bypass grafts both need assessment. A native artery with a graft supplying blood beyond it may have a falsely low FFR — specific interpretation rules apply. FFR helps determine which native vessels and grafts need further intervention.

CTO-PCI outcome assessment

After a chronic total occlusion is successfully opened, FFR or RFR of the newly revascularised vessel confirms adequate blood flow restoration and guides optimal stent placement — particularly important given the complexity and length of CTO lesions.

Diffuse coronary disease

When the angiogram shows diffuse, long-segment disease rather than a focal blockage, a pullback FFR measurement — recording the pressure ratio as the wire is slowly withdrawn from the distal vessel — identifies where the dominant pressure drop occurs. This guides whether focal stenting, long stenting, or medical management is the best strategy.

How is the FFR test done? What to expect

The FFR test is performed as part of your coronary angiogram — there is no separate procedure, no additional hospital admission, and no additional recovery time. Here is exactly what happens:

Before the FFR assessment

• Your coronary angiogram is performed in the standard way. Dr. Bhishma Chowdary reviews the images and identifies any borderline coronary artery lesion(s) that may require physiological assessment.
• The decision to proceed with FFR is made in the catheterization laboratory. You will be informed about the need for the additional assessment, and your consent will be confirmed before the measurement is performed.
• If adenosine-based FFR is used, an IV cannula will already be in place from the angiogram procedure. Adenosine may be administered either intravenously or directly into the coronary artery to achieve maximal blood flow for accurate assessment.

During the FFR measurement

• Pressure Wire Placement: A specially designed pressure-sensing guidewire, thinner than a human hair and equipped with a tiny pressure sensor near its tip, is advanced through the guide catheter and positioned at the entrance of the coronary artery.
• Wire Calibration (Equalisation): The wire is calibrated to ensure that the pressure measured at the sensor tip is equal to the aortic pressure when both are located in the same position.
• Crossing the Lesion: The guidewire is carefully advanced beyond the blockage into the section of the artery distal to the narrowing.
• Adenosine Administration for FFR: If adenosine-based FFR is being performed, adenosine is administered to achieve maximal blood flow. You may experience a brief sensation of chest heaviness, flushing, or mild breathlessness lasting 10–20 seconds, which resolves immediately once the medication effect subsides.
• iFR/RFR Measurement: If iFR or RFR is being used, no adenosine is required. The pressure measurement is obtained at rest during the wave-free period, and patients typically do not feel any additional sensation.
• Pressure Ratio Analysis: The pressure ratio is calculated automatically and displayed on the monitoring console, allowing Dr. Bhishma Chowdary to interpret the result immediately.
• Assessment of Multiple Lesions: If more than one coronary narrowing requires evaluation, the pressure wire is repositioned accordingly. The complete physiological assessment generally adds only 5–15 minutes to the overall procedure time.

After the FFR assessment

• Discussion of Results: Dr. Bhishma Chowdary discusses the FFR or iFR result with you immediately after the assessment, either in the catheterization laboratory or in the recovery area shortly thereafter.
• Normal Physiological Assessment: If the FFR value is above 0.80 (or the iFR value is above 0.89), the blockage is not considered significant enough to require stenting. Medical therapy is optimised, and you will be discharged on appropriate medications without the need for further intervention on that lesion.
• Significant Physiological Assessment: If the FFR value is 0.80 or below, the blockage is considered functionally significant. Angioplasty and stenting may be performed during the same procedure (ad-hoc PCI) or scheduled as a separate intervention, depending on your clinical condition and treatment plan.
• Permanent Record: The FFR or iFR result becomes part of your permanent cardiac record, providing valuable information that guides future clinical decisions regarding that coronary artery.

The evidence base — why FFR-guided treatment is the standard of care

FFR is not simply one option among many — it is the recommended approach for intermediate coronary lesions in the guidelines of every major international cardiology society including the ESC, ACC/AHA, and Cardiological Society of India. The evidence base is exceptionally strong:

FFR test near you — serving Gachibowli, Hitech City, Manikonda and surrounding areas

AIG Hospitals is located in Gachibowli — one of the most accessible locations in western Hyderabad, within easy reach of the region's highest-density cardiac risk population. The FFR programme at AIG Hospitals is available to patients from across the following areas:

No referral needed

You do not need a referral from another doctor to consult Dr. Bhishma Chowdary at AIG Hospitals, Gachibowli. If you have been told you have a borderline heart artery blockage, if your angiogram shows a result your cardiologist is uncertain about, or if you want a second opinion on whether you need a stent — call +91-9000352998 directly to book an appointment. Patients from Gachibowli, Hitech City, Manikonda, Kondapur, and across Hyderabad are seen the same week in most cases.

FFR and the stent decision — when to stent and when not to

The most common question patients ask after being told they have a blockage is: "Do I need a stent?" FFR provides the most objective answer available to this question. Here is how it plays out in practice:

Scenario 1 — FFR above 0.80 (no stent needed)

Your angiogram shows a 55% blockage in the right coronary artery. Without FFR, the decision to stent or not is based on visual assessment — which is unreliable at this severity. FFR is performed. The result is 0.86. This confirms that even at maximum blood flow, the blockage is not restricting supply to the heart muscle sufficiently to cause ischaemia. Dr. Bhishma Chowdary recommends optimising your medications — statin, aspirin, blood pressure, and blood sugar management — and monitoring with regular follow-up. No stent is placed. You avoid 12 months of dual antiplatelet therapy, the small risk of stent thrombosis, and the cost of the procedure.

Scenario 2 — FFR at or below 0.80 (stenting recommended)

Your angiogram shows a 60% blockage in the left anterior descending artery — your main heart artery. You have occasional chest tightness on walking. FFR is performed. The result is 0.74. This confirms significant haemodynamic impairment — the blockage is restricting blood flow, consistent with your symptoms. Dr. Bhishma Chowdary proceeds to angioplasty and stenting in the same sitting. Your symptoms resolve. You are on dual antiplatelet therapy for 12 months and attend follow-up at 4 to 6 weeks.

Scenario 3 — Multivessel disease, FFR guides which to treat

Your angiogram shows three moderate blockages — in the LAD, circumflex, and right coronary artery. Stenting all three would mean a long procedure, high contrast dose, and extended dual antiplatelet therapy. FFR is performed on each. LAD FFR is 0.72 (significant), circumflex FFR is 0.83 (not significant), RCA FFR is 0.79 (borderline — stenting recommended). Only the LAD and RCA are stented. The circumflex is managed medically. You have a simpler procedure, lower risk, and equal long-term outcomes compared to stenting all three.

Frequently asked questions

What does the FFR test cost in Hyderabad?

The cost of FFR testing at AIG Hospitals, Gachibowli includes the pressure wire and adenosine (or no adenosine if iFR/RFR is used) added to the standard coronary angiogram cost. The additional cost is justified by the potential to avoid an unnecessary stent, which carries significantly higher costs and 12 months of antiplatelet medication. For the exact current cost, call +91-9000352998 and our patient care team will provide a complete breakdown. Many insurance plans cover FFR as part of the diagnostic angiogram procedure.

Is the FFR test painful?

For adenosine-based FFR, you may feel a brief 10 to 20 second sensation of chest pressure, flushing, or mild breathlessness when adenosine is administered to achieve maximum blood flow. This is the intended pharmacological effect and typically resolves within 20 to 30 seconds. Most patients describe it as mild and transient. For iFR or RFR (non-adenosine), there is no additional sensation beyond the standard angiogram procedure.

How long does the FFR test take?

FFR adds approximately 5 to 15 minutes to a standard coronary angiogram. For a single lesion, the pressure wire measurement, including adenosine administration or the resting period, usually takes 3 to 5 minutes. Multiple lesions may require proportionally more time. While the overall catheterization laboratory procedure is slightly longer, recovery and discharge times remain unchanged.

My angiogram shows a 50% blockage — do I need an FFR test?

A 50% to 70% stenosis on angiography is considered an intermediate lesion, making it an ideal situation for FFR assessment. Studies have shown that approximately 35% to 40% of visually intermediate lesions are not haemodynamically significant on FFR and therefore do not require stenting. Conversely, some lesions that appear mild on angiography may prove significant on physiological testing. If your angiogram falls within this range and FFR was not performed, it is worth discussing with Dr. Bhishma Chowdary whether physiological assessment is appropriate for your case.

Can FFR be done without a full angiogram?

No. FFR requires catheter access to the coronary artery and placement of a pressure wire beyond the blockage. It is performed as part of an invasive coronary angiogram in the cardiac catheterisation laboratory. However, CT coronary angiography (CCTA) now offers a computational equivalent known as CT-FFR or HeartFlow FFRCT, which estimates FFR values from CT scan data without catheterization. This technology is increasingly available in India and may help determine whether an invasive angiogram and FFR are necessary.

I was told I need a stent without any FFR — should I get a second opinion?

For lesions in the intermediate range (40% to 70% stenosis on angiography), where the decision to proceed with stenting is based solely on visual assessment, requesting FFR evaluation is both reasonable and supported by clinical evidence. Multiple international guidelines recommend FFR for intermediate coronary lesions. Dr. Bhishma Chowdary at AIG Hospitals, Gachibowli offers second-opinion consultations for patients who have been advised to undergo stenting and would like an objective physiological assessment before making a treatment decision. Please bring your angiogram CD and reports to the consultation.

Is FFR available at AIG Hospitals, Gachibowli?

Yes. FFR, iFR, and RFR coronary physiology assessments are available at AIG Hospitals, Gachibowli, Hyderabad. Dr. Bhishma Chowdary routinely uses pressure-wire physiological assessment for intermediate lesions, multivessel coronary artery disease, and left main coronary artery evaluation. The catheterization laboratory is equipped with dedicated FFR/iFR pressure-wire consoles, making physiological assessment a standard component of the interventional cardiology program.

What happens after a normal FFR result — does the blockage go away?

No. A normal FFR result does not mean that the blockage disappears. It indicates that the narrowing is not currently restricting blood flow enough to cause ischaemia or to benefit from stenting. The underlying atherosclerotic plaque remains present and requires ongoing management with medications such as statins, aspirin when appropriate, blood pressure control, and lifestyle modification. Regular follow-up is important because coronary artery disease can progress over time. Dr. Bhishma Chowdary will provide a personalised treatment and follow-up plan based on your FFR results and overall cardiovascular risk profile.

Why choose Dr. Bhishma Chowdary for FFR testing at AIG Hospitals, Gachibowli?

• Routine use of FFR, iFR, and RFR for intermediate and borderline coronary lesions — not an occasional add-on, but a standard part of every angiogram when lesion significance is uncertain.
• Expertise in the full spectrum of coronary physiology assessment, including FFR (adenosine-based), iFR (wave-free resting index), and RFR, with selection of the most appropriate technique for each patient.
• Comprehensive integration of coronary physiology with IVUS and OCT imaging — FFR identifies which lesion requires treatment, while IVUS/OCT ensures optimal stent sizing, placement, and outcomes.
• Evidence-based treatment decisions with every stenting recommendation supported by objective physiological data rather than angiographic appearance alone.
• Active involvement in interventional cardiology research, with presentations at leading scientific meetings including SCAI SHOCK, TCTAP, India Live, and CSI, covering complex coronary physiology and intervention cases.
• Dedicated second-opinion consultations for patients advised coronary stenting without prior FFR assessment. Patients can bring their angiogram CD for an expert review and discussion with Dr. Bhishma Chowdary regarding the true necessity of intervention.
• Conveniently located at AIG Hospitals, Gachibowli, providing easy access for patients from Hitech City, Kondapur, Madhapur, Manikonda, Nanakramguda, and across western Hyderabad.
• Consultations available in English, Hindi, and Telugu to ensure clear communication and personalized patient care.