Fractional Flow Reserve and Coronary Computed Tomographic Angiography

Abstract

Obstructive coronary artery disease (CAD) produces symptoms and increases the risk of adverse cardiac outcomes. However, determining whether a particular coronary stenosis is responsible for causing myocardial ischemia can be challenging, even with invasive coronary angiography (ICA). how should high-risk plaque be incorporated into treatment decisions? (7) how will CT-FFR influence other functional imaging test utilization, and what will be the effect on the practice of cardiology? (8) will a workstationbased CT-FFR be mandatory? Rapid progress to date suggests that CTA-based lesion-specific ischemia will be the gatekeeper to the cardiac catheterization laboratory and will transform the world of intervention.

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

“…The method uses computational fluid dynamics with simulated hyperemia to calculate the FFR measurement at any point in the vascular tree (39). The concept of coronary FFR, defined as the ratio of the mean coronary pressure distal to a coronary stenosis to the mean aortic pressure during maximal coronary blood flow, has evolved into an accepted functional measure of stenosis severity since first proposed 15 years ago (22).…”

“…A FFR value less than 0.80 or less than 0.75 identifies hemodynamic significance of coronary stenosis (7,8). FFR-CT correlates well with invasive-derived FFR measurements in patients with suspected or known CAD (17,39,40). One of the temporary drawbacks is that FFR-CT needs extreme computational ability and analysis time, which hampers widespread dissemination.…”

“…FFR-CT is the first noninvasive functional test to use an outcome-based gold standard, that is invasive FFR, rather than one fundamentally based on coronary stenosis measurement (39). The benefits clearly reside in the reduced false positives compared with CTA alone, with the concomitant reduction in unnecessary ICA.…”

Coronary artery calcium scanning in symptomatic patients: Ready for use as a gatekeeper for further testing?

“…The possibility of adding a predictor of fractional flow reserve from the coronary CTA (FFRct) as a means of reducing subsequent unnecessary invasive coronary angiography has recently been described in this regard. 19 …”

The Hemodynamic Impact of Unstable Coronary Plaques — Do We Have the Evidence?

“…3 TAG, myocardial perfusion, and CT and CT-FFR are the most common studied imaging tools for the assessment of lesion-specific ischemia, because ischemia-guided revascularization can significantly improve patient outcomes. 4 CT-FFR proved superior to TAG, CTAevaluated stenosis degree or the combination of the two in terms of diagnostic accuracy in the DISCOVER-FLOW and DeFACTO studies.…”