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Updates on Fractional Flow Reserve Derived by CT (FFRCT)

  • Imaging (Q Truong, Section Editor)
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Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Fractional flow reserve (FFR) effectively identifies coronary stenoses that are safe to be managed medically. The advent of non-invasive FFR using computed tomography (CT) (FFRCT) datasets has been shown to increase the proportion of patients going to the catheter laboratory and ultimately receiving percutaneous coronary intervention (PCI). This review provides an update on the current status of FFRCT in modern practice and discusses recent applications.

Recent findings

Several studies have reported an association between high-risk plaque features and lower FFRCT values. Furthermore, the concept of delta (Δ) FFR, or translesional gradient, may allow for additional prognostication. Machine learning algorithms have been validated against FFRCT for lesion-specific physiology. Whether FFRCT can predict the effect of different PCI strategies using virtual stenting with reduced order models derived from the computational fluid dynamics simulations is under investigation. These models can quickly recalculate FFRCT post-virtual implant, potentially enabling real-time procedural planning.

Summary

Rapid technological advancement has propelled FFRCT to the forefront of non-invasive assessment of lesion-specific physiology in patients with stable coronary artery disease, increasing the specificity of CT coronary angiography and enriching the catheterization laboratory population. Novel applications such as virtual stenting and machine learning algorithms have the potential to further improve outcomes, but cost and lack of reimbursement in certain healthcare settings are important limitations.

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Acknowledgments

The authors thank Dr. Jaydeep Halankar, Tim Fonte, and HeartFlow, Inc., Redwood City, CA, USA.

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Authors and Affiliations

  1. Center for Heart Valve Innovation, St Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada

    Subhashaan Sreedharan BSc(Hons), Sagit Ben Zekry MD, Jonathon A. Leipsic MD & Richard A. Brown MD

  2. Department of Radiology, University of British Columbia, 170-6371 Crescent Road, Vancouver, British Columbia, V6T 1Z2, Canada

    Subhashaan Sreedharan BSc(Hons), Sagit Ben Zekry MD, Jonathon A. Leipsic MD & Richard A. Brown MD

  3. Department of Radiology, St Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada

    Subhashaan Sreedharan BSc(Hons), Sagit Ben Zekry MD, Jonathon A. Leipsic MD & Richard A. Brown MD

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  1. Subhashaan Sreedharan BSc(Hons)
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Dr Leipsic has been a consultant for and holds stock in Circle Cardiovascular Imaging and HeartFlow and provides core lab services for NIH, Edwards Lifesciences, Neovasc, Abbott and Medtronic.

Dr Leipsic has also been a member of the Speakers Bureau for GE Healthcare and Edwards LifeSciences, received research support from GE Healthcare and grant support from the Canadian Institutes of Health Research (CIHR), National Institutes of Health (NIH), GE Healthcare and HeartFlow.

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Sreedharan, S., Zekry, S.B., Leipsic, J.A. et al. Updates on Fractional Flow Reserve Derived by CT (FFRCT). Curr Treat Options Cardio Med 22, 17 (2020). https://doi.org/10.1007/s11936-020-00816-y

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