CT-derived fractional flow reserve (CT-FFR) uses computational fluid dynamics to derive non-invasive FFR to determine the haemodynamic significance of coronary artery lesions. Studies have demonstrated good diagnostic accuracy of CT-FFR and reassuring short-term clinical outcome data.
As a prerequisite, high-quality CT coronary angiography (CTCA) images are required with good heart rate control and pre-treatment with glyceryl trinitrate, which would otherwise render CTCA as unsuitable for CT-FFR. CT-FFR can determine the functional significance of CAD lesions, and there are supportive data for its use in clinical decision-making. However, the downstream impact on myocardial ischaemic burden or viability cannot be obtained.
Several challenges remain with implementation of CT-FFR, including interpretation, training, availability, resource utilisation and funding. Further research is required to determine which cases should be considered for clinical CT-FFR analysis, with additional practical guidance on how to implement this emerging technique in clinical practice. Furthermore, long-term prognostic data are required before widespread clinical implementation of CT-FFR can be recommended.
While there are several potential opportunities for CT-FFR, at present there remain important systemic and technical limitations and challenges that need to be overcome prior to routine integration of CT-FFR into clinical practice.
- cardiac computer tomographic (CT) imaging
- advanced cardiac imaging
- coronary artery disease
- chronic coronary disease
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Contributors MSN and EDN conceived the idea of the manuscript. MSN drafted the initial manuscript. TKM, JW-M, KN, KC and EDN all critically revised the manuscript. All authors read and approved the final manuscript.
Funding MSN is funded by a Clinical Lecturership awarded by the UK National Institute for Health Research.
Competing interests KN declares unrestricted, institutional research support from Siemens Healthineers, Bayer Healthcare and HeartFlow Inc.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Obtained.
Provenance and peer review Commissioned; externally peer reviewed.