In the current issue of Cardiovascular Innovations and Applications volume 4, issue 1, pp. 31-42(12) ; DOI https://doi.org/10.15212/CVIA.2019.0003, Talal Alzahrani, MD, Ahmed Tashkandi, MD, Abdullah Sarkar, MD, Claudio Smuclovisky, MD, James P. Earls, MD and Andrew D. Choi, MD, from the Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA; Department of Medicine, University of Miami, Miami, FL, USA; Diagnostic Imaging Center, Holy Cross Hospital, Fort Lauderdale, FL, USA and the Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA consider practical clinical applications of cardiac computed tomography-derived fractional flow reserve.
In the past decade, advances in coronary computed tomography angiography (CTA) technology have resulted in high sensitivity and negative predictive value in detecting coronary artery disease (CAD) compared with invasive coronary angiography, particularly for patients with mild or severe stenosis. However, anatomical evaluation of CAD by CTA has modest specificity for patients with intermediate-grade stenoses. The recent development of the use of cardiac computed tomography-derived fractional flow reserve (FFR-CT) seeks to address this gap as a proposed method of functional assessment of CAD by CTA. In this article the authors mix common clinical cases with the current technical methods, validation, outcomes, and registry studies as well as the technical, financial and research limitations of FFRCT analysis to guide the cardiac imaging specialist in evaluating this technique. FFR-CT analysis may help reduce additive functional testing for the smaller proportion of patients with intermediate stenosis undergoing coronary CTA where the atherosclerosis significance is uncertain.