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

To summarize the scientific basis of CT derived fractional flow reserve (FFR_CT) 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), FFR_CT showed high diagnostic performance. More recently, FFR_CT has advanced to the realm of clinical utility and real-world clinical practice with emerging data showing that FFR_CT 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, FFR_CT may broaden applicability of frontline coronary CTA testing to patients with high pre-test risk of CAD. Introducing FFR_CT into clinical practice has the potential to significantly improve the management of patients with stable CAD. The optimal FFR_CT testing interpretation strategy, as well as the relative cost-efficiency of FFR_CT against standard noninvasive functional testing, need further investigation.