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

Journal: Journal of cardiovascular computed tomography
Published Date: Jun 12, 2025

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.

Authors

  • 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
    Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: marton.kolossvary@cirg.hu.
  • Kashif Shaikh
    University of Tennessee Medical Center, Knoxville (K.S.).
  • 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
    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 Ribeiro Gavina 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
    Cardiology Service, Walter Reed National Military Center, Bethesda, MD, USA.
  • Abdul Rahman Ihdayhid
    Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Melbourne, Victoria, Australia 3168 (A.R.I.); and Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (S.B.Z.).

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