Coronary Computed Tomography Angiography–derived Fractional Flow Reserve

Abstract

Invasive fractional flow reserve (FFR) measured by a pressure wire is a reference standard for evaluating functional stenosis in coronary artery disease. Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) uses advanced computational analysis methods to noninvasively obtain FFR results from a single conventional coronary computed tomography angiography data to evaluate the hemodynamic significance of coronary artery disease. More and more evidence has found good correlation between the results of noninvasive CT-FFR and invasive FFR. CT-FFR has proven its potential in optimizing patient management, improving risk stratification and prognosis, and reducing total health care costs. However, there is still a lack of standardized interpretation of CT-FFR technology in real-world clinical settings. This expert consensus introduces the principle, workflow, and interpretation of CT-FFR; summarizes the stateof-the-art application of CT-FFR; and provides suggestions and recommendations for the application of CT-FFR with the aim of promoting the standardized application of CT-FFR in clinical practice.

Optimal Measurement Sites of Coronary-Computed Tomography Angiography-derived Fractional Flow Reserve

“…[3][4][5][6][7] Compared with invasive FFR, an increasing body of evidence suggests that FFR CT provides an additive role in therapeutic guidance, showing the potential to streamline and rationalize the care of patients suspected of having coronary artery disease (CAD), improving the outcomes and reducing overall health care costs. [6][7][8][9][10][11][12][13][14] Actually, FFR CT measured at different sites could have an impact on the assessment of diagnostic accuracy of hemodynamic ischemia and prognosis. According to previous studies, 15,16 measuring sites of invasive FFR with a pressure wire placed at 2 to 3 cm (or 5 to 10 times the proximal vessel reference diameter) distal to the stenosis were recommended.…”

“…Emerging computational fluid dynamics modeling techniques allow noninvasive calculation of FFR (FFR CT ) derived from coronary-computed tomography angiography (CCTA) with substantially improved diagnostic performance for detecting myocardial ischemia 3–7. Compared with invasive FFR, an increasing body of evidence suggests that FFR CT provides an additive role in therapeutic guidance, showing the potential to streamline and rationalize the care of patients suspected of having coronary artery disease (CAD), improving the outcomes and reducing overall health care costs 6–14…”

Can the Application of Fractional Flow Reserve Computed Tomography in High-risk Patients With Chronic Coronary Syndrome Obviate Downstream Diagnostic Invasive Coronary Procedures?

“…Therefore, coronary CTA assessment in a group of high-risk patients has an increasing role 6 . Beyond ruling out CAD, novel noninvasive, functional utilities are more widely used in the preprocedural, virtual planning of coronary interventions 7 …”

“…6 Beyond ruling out CAD, novel noninvasive, functional utilities are more widely used in the preprocedural, virtual planning of coronary interventions. 7 While anatomic evaluation provides excellent negative predictive value, additional functional assessment with FFR-CT improves diagnostic specificity, and integrating FFR-CT results with CTA findings has been shown to reduce the number of nonactionable ICAs more effectively than CTA alone. 8 However, current indications to perform FFR-CT extend to stenoses of <50%.…”

Cardiothoracic Imaging in China

“…To facilitate the dissemination of advanced cardiovascular imaging techniques in a standardized manner across China, Chinese cardiothoracic radiologists are actively involved in the development, promotion, and application of clinical guidelines, expert consensus, and recommendations. In this special issue, we publish the Chinese expert consensus document addressing CT-FFR on behalf of the Chinese Society of Radiology 12. Nowadays, Chinese cardiothoracic radiologists are pushing these advanced cardiovascular imaging techniques into clinical routine applications, an additional effort to lay a solid foundation for future research.…”