Coronary CT Angiography-Derived Fractional Flow Reserve

Purpose of Review Coronary CT angiography has been shown to be highly diagnostically accurate as compared with invasive coronary angiography and help clinical decision making that affords improved clinical outcomes. Unfortunately, routine coronary CTA does not allow for the discrimination of the hemodynamic significance of stenosis. Recently, through the integration of computational fluid dynamics, Fractional Flow Reserve CT (FFRct) has been developed which allows for the determination of the hemodynamic significance of specific lesions from a resting coronary CTA without additional imaging, a change in protocol or the administration of adenosine. Recent Findings FFRct has been validated in three large multicenter trials and has been shown to be the most accurate noninvasive test for lesion-specific ischemia as compared with the invasive gold standard of FFR. Importantly, FFRct has been shown also to be highly clinically useful in both trial and real-world settings affording a reduction in the burden of nonobstructive disease at the time of invasive angiography enabling a significant reduction in cost. Summary FFRct is a novel technique that for the first time allows for a nonbiased noninvasive three-vessel FFR that compares favorably with the invasive gold standard of lesion-specific ischemia. FFRct is proving helpful not only for the adjudication of lesion-specific ischemia but also to help advance our understanding of mechanisms of risk and myocardial infarction. The clinical role of FFRct is being defined with growing registry and real-world data.