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Open Access Practical Clinical Application of Cardiac Computed Tomography–Derived Fractional Flow Reserve

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In the past decade, advances in coronary computed tomography angiography (CTA) technology have resulted in high sensitivity and negative predictive value in detecting coronary artery disease (CAD) compared with invasive coronary angiography, particularly for patients with mild or severe stenosis. However, anatomical evaluation of CAD by CTA has modest specificity for patients with intermediate-grade stenoses. The recent development of the use of cardiac computed tomography–derived fractional flow reserve (FFR-CT) seeks to address this gap as a proposed method of functional assessment of CAD by CTA. In this article we aim to mix common clinical cases with the current technical methods, validation, outcomes, and registry studies as well as the technical, financial and research limitations of FFRCT analysis to guide the cardiac imaging specialist in evaluating this technique. FFR-CT analysis may help reduce additive functional testing for the smaller proportion of patients with intermediate stenosis undergoing coronary CTA where the atherosclerosis significance is uncertain.
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Keywords: coronary artery disease; cardiac computed tomography; fractional flow reserve; fractional flow reserve derived by computed tomography; Ischemia

Affiliations: The George Washington University School of Medicine, Washington, DC, USA

Appeared or available online: February 7, 2019

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