CT derived fractional flow reserve: Part 2 - Critical appraisal of the literature

Patricia F. Rodriguez-Lozano, Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA; Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA.
Anam Waheed, Medstar Heart and Vascular Center, Washington Hospital Center, Georgetown University Hospital, Washington, DC, USA.
Sotirios Evangelou, Department of Cardiology, European Interbalkan Medical Center, Thessaloniki, Greece.
Márton Kolossváry, Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary.
Kashif Shaikh, Department of Medicine, Division of Cardiology, University of Tennessee, Knoxville, TN, USA.
Saira Siddiqui, Department of Pediatrics, Morristown Medical Center, Morristown, NJ, USA; Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Lauren Stipp, Department of Cardiology, Ascension Sacred Heart Emerald Coast, Miramar Beach, FL, USA.
Suvasini Lakshmanan, Department of Cardiology, Lundquist Institute of Biomedical Innovation and Research, Los Angeles, CA, USA.
En-Haw Wu, Department of Diagnostic Radiology, Oregon Health and Science University, OR, USA.
Nick S. Nurmohamed, Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.
Ady Orbach, Department of Cardiology, Edith Wolfson Medical Center, Holon, Israel.
Vinit Baliyan, Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Joao Francisco de Matos, Department of Medical Imaging Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada.
Siddharth J. Trivedi, Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Nidhi Madan, UnityPoint Health St Luke's Hospital, Cedar Rapids, IA, USA.
Todd C. Villines, Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA.
Abdul Rahman Ihdayhid, Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia; Curtin Medical School, Curtin University, Perth, Western Australia, Australia. Electronic address: abdul.ihdayhid@perkins.org.au.

Document Type

Journal Article

Publication Date

6-12-2025

Journal

Journal of cardiovascular computed tomography

DOI

10.1016/j.jcct.2025.05.241

Keywords

Computational fractional flow reserve; Coronary artery disease; Coronary computed tomography angiography

Abstract

The integration of computed tomography-derived fractional flow reserve (CT-FFR), utilizing computational fluid dynamics and artificial intelligence (AI) in routine coronary computed tomographic angiography (CCTA), presents a promising approach to enhance evaluations of functional lesion severity. Extensive evidence underscores the diagnostic accuracy, prognostic significance, and clinical relevance of CT-FFR, prompting recent clinical guidelines to recommend its combined use with CCTA for selected individuals with with intermediate stenosis on CCTA and stable or acute chest pain. This manuscript critically examines the existing clinical evidence, evaluates the diagnostic performance, and outlines future perspectives for integrating noninvasive assessments of coronary anatomy and physiology. Furthermore, it serves as a practical guide for medical imaging professionals by addressing common pitfalls and challenges associated with CT-FFR while proposing potential solutions to facilitate its successful implementation in clinical practice.

Department

School of Medicine and Health Sciences Resident Works

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