Opportunities and challenges of implementing computed tomography fractional flow reserve into clinical practice

Heart. 2020 Sep;106(18):1387-1393. doi: 10.1136/heartjnl-2019-315607. Epub 2020 Jun 19.

Abstract

CT-derived fractional flow reserve (CT-FFR) uses computational fluid dynamics to derive non-invasive FFR to determine the haemodynamic significance of coronary artery lesions. Studies have demonstrated good diagnostic accuracy of CT-FFR and reassuring short-term clinical outcome data.As a prerequisite, high-quality CT coronary angiography (CTCA) images are required with good heart rate control and pre-treatment with glyceryl trinitrate, which would otherwise render CTCA as unsuitable for CT-FFR. CT-FFR can determine the functional significance of CAD lesions, and there are supportive data for its use in clinical decision-making. However, the downstream impact on myocardial ischaemic burden or viability cannot be obtained.Several challenges remain with implementation of CT-FFR, including interpretation, training, availability, resource utilisation and funding. Further research is required to determine which cases should be considered for clinical CT-FFR analysis, with additional practical guidance on how to implement this emerging technique in clinical practice. Furthermore, long-term prognostic data are required before widespread clinical implementation of CT-FFR can be recommended.While there are several potential opportunities for CT-FFR, at present there remain important systemic and technical limitations and challenges that need to be overcome prior to routine integration of CT-FFR into clinical practice.

Keywords: advanced cardiac imaging; cardiac computer tomographic (CT) imaging; chronic coronary disease; coronary artery disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Clinical Decision-Making
  • Computed Tomography Angiography*
  • Coronary Angiography*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / therapy
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / physiopathology
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Hydrodynamics
  • Models, Cardiovascular
  • Predictive Value of Tests
  • Prognosis
  • Radiographic Image Interpretation, Computer-Assisted
  • Reproducibility of Results
  • Severity of Illness Index