Specialist commentator comments

Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Five specialists provided comments, all of whom were aware of the technology or concept, and 1 had used it in a research/demonstration capacity.

Level of innovation

All the specialists considered the technology to be innovative. Two experts noted that similar competing technologies existed and 1 noted that these (fractional flow reserve [FFR] and instantaneous wave-free ratio [iFR]) had an excellent evidence base, and had been widely adopted in the NHS so it potentially had a less compelling case for adoption in the NHS. One considered the technology to be potentially disruptive to the care pathway.

Potential patient impact

The specialists considered that the technology could avoid the need for invasive FFR measurement and the risks associated with the passage of a guide wire, and the side effects associated with adenosine or other vasodilator drugs. One considered it had the potential to improve diagnostic accuracy and avoid further procedures or repeat investigations.

Potential system impact

The specialists considered that the technology could potentially save money and produce system benefits through avoiding invasive measurement of FFR and reducing procedure time, and therefore throughput in ICA. One specialist stated that further evidence was needed on this, and 1 stated that the comparator was important with it likely to save money against invasive coronary angiography (ICA) alone but less certain against FFR and iFR.

General comments

The specialists noted that in addition to potentially replacing FFR and iFR, it could also reduce other functional tests (Echo/MRI/Spect) and FFRCT.

They were split on the appropriateness of NICE guidance. They considered the potential obstacles to adoption, from the cost of the technology to the lack of clinical data, and the widespread belief in FFR as the 'gold standard' assessment.