Interventional cardiologists take on angiography-derived physiology in new expert opinion
The Society for Cardiovascular Angiography and Interventions (SCAI) has shared a new expert opinion focused on one of the biggest trends in interventional cardiology: angiography-derived physiology (ADP).
ADP is a wire-free, anticoagulant-free way to secure fractional flow reserve (FFR) estimates of a patient’s coronary physiology using high-quality diagnostic angiograms. Artificial intelligence (AI) often plays a key role, as it does with the Medis QFR software developed by Medis Medical Imaging and FFRangio system developed by CathWorks.
Wire-based physiologic assessments are still typically the best way to evaluate coronary stenosis, but ADP is associated with several benefits—including fewer risks, shorter procedure times and lower healthcare costs—that could help it gain widespread implementation in a way that never happened with wire-based physiology.
This expert opinion was based on a 2025 roundtable of 17 cardiologists, including 16 interventional cardiologists. The panel reviewed the latest evidence, evaluated commercially available ADP offerings, discussed best practices and explored the growing influence this technology is having among today’s clinicians. The final manuscript was published in JSCAI, the official journal of SCAI.[1]
The FFRangio System for noninvasive FFR evaluations from CathWorks. Image courtesy of CathWorks.
“Physiological assessment using pressure wires remains the gold standard for evaluating intermediate coronary lesions, yet utilization is only 10–20%,” Evan Shlofmitz, DO, director of intravascular imaging at St. Francis Hospital in Roslyn, New York, and first author of the expert opinion, said in a statement. “ADP has the potential to address many of these barriers. The use of ADP has advanced quickly, and many interventionalists are encountering these tools without a clear framework for interpretation or application. Our goal was to rigorously evaluate the evidence, define where ADP offers meaningful clinical value today and clearly articulate the limitations and unanswered questions that must be addressed before broader adoption.”
“This expert opinion helps clinicians understand where ADP can responsibly complement wire-based physiology today and where caution and further data remain necessary,” added William F. Fearon, MD, chief of interventional cardiology at Stanford University School of Medicine and the VA Palo Alto Health Care System,
The roundtable used to craft this expert opinion was funded by CathWorks and Medtronic, though neither company played a role in developing or editing the final manuscript. Medtronic just agreed to acquire CathWorks for up to $585 million.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.