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Current Evidence in Cardiothoracic Imaging: Computed Tomography-derived Fractional Flow Reserve in Stable Chest Pain

Fides R Schwartz1, Lynne M Koweek1, Bjarne L Nørgaard2

  • 1Department of Radiology, Duke University Medical Center, Durham, NC.

Journal of Thoracic Imaging
|October 31, 2018
PubMed

Insights

Computed tomography coronary angiography offers accurate anatomical assessment for coronary artery disease. Fractional flow reserve derived from computed tomography provides reliable functional evaluation, aiding in diagnosis and risk stratification.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Medical Diagnostics

Background:

  • Coronary artery disease (CAD) diagnosis and management require high-accuracy imaging for risk stratification.
  • Multidetector computed tomography (MDCT) and advanced postprocessing enable detailed anatomical assessment via computed tomography coronary angiography (CTCA).
  • Functional assessment of stenosis severity is crucial for guiding treatment decisions.

Purpose of the Study:

  • To review the diagnostic performance of fractional flow reserve derived from computed tomography (CT-FFR).
  • To discuss the potential clinical impact of CT-FFR in managing patients with suspected or known coronary artery disease.
  • To compare CT-derived assessments with invasive methods.

Main Methods:

  • Review of current literature on computed tomography coronary angiography (CTCA) and CT-derived fractional flow reserve (CT-FFR).
  • Comparison of diagnostic accuracy of CTCA for luminal stenosis with invasive coronary angiography.
  • Evaluation of CT-FFR for determining the hemodynamic significance of coronary stenoses, compared to invasive fractional flow reserve (FFR).

Main Results:

  • CTCA provides anatomic luminal assessment comparable to invasive coronary angiography.
  • CT-derived fractional flow reserve (CT-FFR) demonstrates comparable performance to invasive FFR in identifying hemodynamically significant stenosis.
  • These non-invasive techniques facilitate accurate diagnosis and risk stratification for coronary artery disease.

Conclusions:

  • CTCA and CT-derived fractional flow reserve (CT-FFR) represent significant advancements in non-invasive diagnostic imaging for coronary artery disease.
  • The integration of CTCA and CT-FFR holds substantial potential to impact clinical practice by improving diagnostic accuracy and guiding patient management.
  • These methods offer a comprehensive approach to assessing both anatomy and physiology in CAD.

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