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Fractional flow reserve derived from coronary computed tomography: where are we now and where are we heading?
Lavinia Gabara1,2, Jonathan Hinton1,2, Thomas Russell Gilpin1,2
1Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
Insights
Computed tomography-derived fractional flow reserve (FFRCT) offers a non-invasive way to assess coronary artery disease severity. This advanced imaging technique provides both anatomical and physiological information, aiding in patient management and reducing healthcare costs.
Area of Science:
- Cardiovascular imaging
- Medical diagnostics
- Computational fluid dynamics
Background:
- Computed tomography coronary angiography is increasingly used for chest pain evaluation.
- Assessing myocardial ischemia extent and distribution is crucial for personalized patient management.
Purpose of the Study:
- To evaluate the role of computed tomography-derived fractional flow reserve (FFRCT) in diagnosing coronary artery disease.
- To highlight FFRCT's ability to provide both anatomical and physiological assessment in a single non-invasive test.
Main Methods:
- FFRCT utilizes raw computed tomography coronary angiography data.
- Complex computational fluid dynamics are employed to process the data.
- The derived FFRCT values serve as a surrogate for invasive fractional flow reserve (FFR).
Main Results:
- FFRCT has been extensively validated against invasive FFR.
- Clinical studies show FFRCT effectively guides invasive angiography decisions.
- FFRCT use is associated with reduced downstream clinical events and costs.
Conclusions:
- FFRCT is a valuable non-invasive tool for assessing coronary artery disease.
- It aids in optimizing patient management and healthcare resource utilization.
- Future research will further define the role of novel FFRCT estimation models in clinical practice.
Abstract:
Computed tomography coronary angiography is emerging as the preferred diagnostic tool for patients with chest pain. Additional knowledge of the extent and distribution of myocardial ischemia enables tailored patient management. Computed tomography-derived fractional flow reserve (FFRCT) employs computed tomography coronary angiography raw data processed via complex computational fluid dynamics and produces a surrogate of the invasive fractional flow reserve (FFR) thus delivering anatomical and physiological assessment in a single test. FFRCT has been extensively validated against invasive FFR and observational clinical studies have consistently demonstrated its utility as gatekeeper to invasive angiography while also reducing downstream clinical events and costs. Novel workstation-based models of estimating FFR are now being tested. Ongoing and future research results will define their role in clinical practice.
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