CT derived fractional flow reserve: Part 2 - Critical appraisal of the literature.
Authors
Affiliations (17)
Affiliations (17)
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA; Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA.
- Medstar Heart and Vascular Center, Washington Hospital Center, Georgetown University Hospital, Washington, DC, USA.
- Department of Cardiology, European Interbalkan Medical Center, Thessaloniki, Greece.
- Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary.
- Department of Medicine, Division of Cardiology, University of Tennessee, Knoxville, TN, USA.
- Department of Pediatrics, Morristown Medical Center, Morristown, NJ, USA; Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
- Department of Cardiology, Ascension Sacred Heart Emerald Coast, Miramar Beach, FL, USA.
- Department of Cardiology, Lundquist Institute of Biomedical Innovation and Research, Los Angeles, CA, USA.
- Department of Diagnostic Radiology, Oregon Health and Science University, OR, USA.
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.
- Department of Cardiology, Edith Wolfson Medical Center, Holon, Israel.
- Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Medical Imaging Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada.
- Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- UnityPoint Health St Luke's Hospital, Cedar Rapids, IA, USA.
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA.
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia; Curtin Medical School, Curtin University, Perth, Western Australia, Australia. Electronic address: [email protected].
Abstract
The integration of computed tomography-derived fractional flow reserve (CT-FFR), utilizing computational fluid dynamics and artificial intelligence (AI) in routine coronary computed tomographic angiography (CCTA), presents a promising approach to enhance evaluations of functional lesion severity. Extensive evidence underscores the diagnostic accuracy, prognostic significance, and clinical relevance of CT-FFR, prompting recent clinical guidelines to recommend its combined use with CCTA for selected individuals with with intermediate stenosis on CCTA and stable or acute chest pain. This manuscript critically examines the existing clinical evidence, evaluates the diagnostic performance, and outlines future perspectives for integrating noninvasive assessments of coronary anatomy and physiology. Furthermore, it serves as a practical guide for medical imaging professionals by addressing common pitfalls and challenges associated with CT-FFR while proposing potential solutions to facilitate its successful implementation in clinical practice.