Area stenosis associated with non-invasive fractional flow reserve obtained from coronary CT images

Coronary artery disease (CAD) patients may have an obstructive disease on invasive coronary angiography, but few of these patients have had flow-limiting obstructive disease diagnosed on invasive fractional flow reserve (FFR). FFR is infrequently performed because of its cost- and time-effectiveness. Advancement in non-invasive imaging has enabled FFR to be derived non-invasively using coronary CT angiography (CCTA), without the need for induction of hyperemia or modification of the standard CCTA acquisition protocol. FFR derived from CCTA (FFRCT) has been shown to have excellent correlation with invasive FFR, and remains an effective diagnostic tool in the presence of reduced signal-to-noise ratio, coronary calcification and motion artifact. The utility of FFRCT has also helped to deepen our understanding of hemodynamically significant CAD. Hence, there is now interest in exploring the possible interplay between these mechanistic forces and their effect on the development of coronary plaque and the vulnerability of these plaques.

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Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing?

European Radiology ◽

10.1007/s00330-015-3619-1 ◽

2015 ◽

Vol 25 (8) ◽

pp. 2282-2290 ◽

Cited By ~ 19

Author(s):

B. L. Nørgaard ◽

J. M. Jensen ◽

J. Leipsic

Keyword(s):

Ct Angiography ◽

Coronary Disease ◽

Fractional Flow Reserve ◽

Coronary Ct Angiography ◽

Fractional Flow ◽

Non Invasive ◽

Coronary Ct ◽

Flow Reserve

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Diagnostic performance of a fast non-invasive fractional flow reserve derived from coronary CT angiography: an initial validation study

Clinical Radiology ◽

10.1016/j.crad.2019.08.007 ◽

2019 ◽

Vol 74 (12) ◽

pp. 973.e1-973.e6 ◽

Cited By ~ 1

Author(s):

L. Yang ◽

L. Xu ◽

J. He ◽

Z. Wang ◽

Z. Sun ◽

...

Keyword(s):

Ct Angiography ◽

Fractional Flow Reserve ◽

Validation Study ◽

Diagnostic Performance ◽

Coronary Ct Angiography ◽

Fractional Flow ◽

Non Invasive ◽

Initial Validation ◽

Coronary Ct ◽

Flow Reserve

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Fractional Flow Reserve: Does a Cut-off Value add Value?

Interventional Cardiology Review ◽

10.15420/icr.2016.11.01.17 ◽

2016 ◽

Vol 11 (1) ◽

pp. 17

Author(s):

Shah R Mohdnazri ◽

◽

Thomas R Keeble ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Coronary Intervention ◽

Grey Zone ◽

Fractional Flow ◽

Non Invasive ◽

Invasive Test ◽

Flow Reserve ◽

A Value ◽

Percutaneous Coronary ◽

Value Add

Fractional flow reserve (FFR) has been shown to improve outcomes when used to guide percutaneous coronary intervention (PCI). There have been two proposed cut-off points for FFR. The first was derived by comparing FFR against a series of non-invasive tests, with a value of ≤0.75 shown to predict a positive ischaemia test. It was then shown in the DEFER study that a vessel FFR value of ≥0.75 was associated with safe deferral of PCI. During the validation phase, a ‘grey zone’ for FFR values of between 0.76 and 0.80 was demonstrated, where a positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI.

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