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Coronary CT Angiography Derived Fractional Flow Reserve: The Game Changer in Noninvasive Testing

  • Cardiac PET, CT, and MRI (F Pugliese and SE Petersen, Section Editors)
  • Published:
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Abstract

Purpose of Review

To summarize the scientific basis of CT derived fractional flow reserve (FFRCT) and present an updated review on the evidence from clinical trials and real-world observational data

Recent Findings

In prospective multicenter studies of patients with stable coronary artery disease (CAD), FFRCT showed high diagnostic performance. More recently, FFRCT has advanced to the realm of clinical utility and real-world clinical practice with emerging data showing that FFRCT when compared to standard care is efficient in safely reducing downstream utilization of invasive coronary angiography (ICA), and costs, as well as improving the diagnostic yield of ICA. Moreover, FFRCT may broaden applicability of frontline coronary CTA testing to patients with high pre-test risk of CAD.

Summary

Introducing FFRCT into clinical practice has the potential to significantly improve the management of patients with stable CAD. The optimal FFRCT testing interpretation strategy, as well as the relative cost-efficiency of FFRCT against standard noninvasive functional testing, need further investigation.

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Abbreviations

ADVANCE:

Assessing diagnostic value of non-invasive FFRCT in coronary care

CAD:

Coronary artery disease

CTA:

Computed tomography angiography

DeFACTO:

Determination of fractional flow reserve by anatomic computed tomographic angiography

DISCOVER-FLOW:

Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms

EMERALD:

Exploring the mechanism of the plaque rupture in acute myocardial infarction

FDA:

United States Food and Drug Administration

FFR:

Fractional flow reserve

FFRCT :

Coronary computed tomography angiography derived fractional flow reserve

ICA:

Invasive coronary angiography

LAD:

Left anterior descending artery

NICE:

United Kingdom National Institute for Health and Care Excellence

NXT:

Analysis of coronary blood flow using CT angiography, next steps

PROMISE:

Outcomes of anatomical versus functional testing for coronary artery disease

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Authors and Affiliations

  1. Department Cardiology, Aarhus University Hospital, 8200, Aarhus N, Denmark

    Bjarne Linde Nørgaard & Jesper Møller Jensen

  2. Department of Radiology and Medicine, St. Paul´s Hospital, University of British Columbia, Vancouver, Canada

    Philipp Blanke & Jonathon Leipsic

  3. Department Cardiology, Hospital of South West Denmark, Esbjerg, and Institute of regional Health Research, University of Southern Denmark, Esbjerg, Denmark

    Niels Peter Sand

  4. Medicine and Radiology, Division of Cardiology, Loyola University Chicago, Chicago, Illinois, USA

    Mark Rabbat

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  1. Bjarne Linde Nørgaard
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Correspondence to Bjarne Linde Nørgaard.

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Conflict of Interest

Dr. Nørgaard has received unrestricted institutional research grants from Siemens, Edwards Lifesciences, and HeartFlow.

Dr. Blanke is a consultant for HeartFlow and Circle Imaging. In addition, he provides Institutional corelab services to Edwards, Medtronic, Tendyne Holdings, and Neovasc.

Dr. Rabbat has received honoraria from HeartFlow.

Dr. Leipsic is a consultant and has stock options in Circle Imaging and Heartflow. In addition, he provides Institutional corelab services to Edwards Lifesciences, Medtronic, Tendyne Holdings, and Neovasc.

Jesper Møller Jensen and Niels Peter Sand have no disclosures.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Cardiac PET, CT, and MRI

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Nørgaard, B.L., Jensen, J.M., Blanke, P. et al. Coronary CT Angiography Derived Fractional Flow Reserve: The Game Changer in Noninvasive Testing. Curr Cardiol Rep 19, 112 (2017). https://doi.org/10.1007/s11886-017-0923-1

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