You are here

Article Text

Article menu
Download PDFPDF
Review
Opportunities and challenges of implementing computed tomography fractional flow reserve into clinical practice
  1. Muhummad Sohaib Nazir1,
  2. Tarun K Mittal2,
  3. Jonathan Weir-McCall3,
  4. Koen Nieman4,
  5. Keith Channon5,
  6. Edward D Nicol6
  1. 1 Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
  2. 2 Imaging, Harefield Hospital, London, Middlesex, UK
  3. 3 University of Cambridge School of Clinical Medicine, Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom, Cambridge, UK
  4. 4 Stanford University School of Medicine and Cardiovascular Institute, Stanford, California, USA
  5. 5 Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
  6. 6 Departments of Cardiology and Radiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
  1. Correspondence to Dr Edward D Nicol, Departments of Cardiology and Radiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK; e.nicol{at}nhs.net

Abstract

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

https://doi.org/10.1136/heartjnl-2019-315607

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Twitter @jweirmccall

    • 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.