European Radiology

, Volume 25, Issue 8, pp 2282–2290

Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing?

Cardiac

DOI: 10.1007/s00330-015-3619-1

Cite this article as:
Nørgaard, B.L., Jensen, J.M. & Leipsic, J. Eur Radiol (2015) 25: 2282. doi:10.1007/s00330-015-3619-1

Abstract

Fractional flow reserve (FFR) measured during invasive coronary angiography is the gold standard for lesion-specific decisions on coronary revascularization in patients with stable coronary artery disease (CAD). Current guidelines recommend non-invasive functional or anatomic testing as a gatekeeper to the catheterization laboratory. However, the “holy grail” in non-invasive testing of CAD is to establish a single test that quantifies both coronary lesion severity and the associated ischemia. Most evidence to date of such a test is based on the addition of computational analysis of FFR to the anatomic information obtained from standard-acquired coronary CTA data sets at rest (FFRCT). This review summarizes the clinical evidence for the use of FFRCT in stable CAD in context to the diagnostic performance of other non-invasive testing modalities.

Key Points

The process of selecting appropriate patients for invasive coronary angiography is inadequate

Invasive fractional flow reserve is the standard for assessing coronary lesion-specific ischemia

Fractional flow reserve may be derived from standard coronary CT angiography (FFRCT)

FFRCTprovides high diagnostic performance in stable coronary artery disease

Keywords

Coronary artery disease Coronary CT angiography Fractional flow reserve Invasive coronary angiography Non-invasive imaging 

Abbreviations

AUC

Area under the receiver operating characteristic curve

CAD

Coronary artery disease

CTA

Computed tomography angiography

CTP

Computed tomography perfusion

CMR

Magnetic resonance myocardial perfusion imaging

FFR

Fractional flow reserve

FFRCT

Fractional flow reserve derived from coronary computed tomography angiography

ICA

Invasive coronary angiography

NPV

Negative predictive value

PPV

Positive predictive value

SPECT

Single photon emission computed tomography

TAG

Transluminal attenuation gradient

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  1. 1.Department of Cardiology BAarhus University Hospital SkejbyAarhus NDenmark
  2. 2.Department RadiologySt. Paul’s HospitalVancouverCanada

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