Review: FFRCT Changing the Face of Cardiac CT
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CARDIAC COMPUTED TOMOGRAPHY (A. CREAN AND G. SMALL, SECTION EDITORS)
Review: FFRCT Changing the Face of Cardiac CT Alex Asher 1 & Andrew Wragg 1 & Ceri Davies 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Non-invasive fractional flow reserve derived from CT coronary angiography (FFRCT) offers an amalgamation of both coronary anatomy and physiology. This review aims to provide a contemporary evaluation of the evidence for clinical use of FFRCT. The review article pays particular attention to the importance of patient preparation, anatomical features, scan quality and the overall interpretation of results that can lead to the best use of FFRCT analysis. Previous cost evaluations of the technology are compared and reviewed. Recent Findings Diagnostic accuracy of FFRCT in comparison with CTA has been established in several clinical studies previously. More recent studies for FFRCT use have focused on the clinical utility of the technology, in comparison with other non-invasive testing for coronary artery disease and the prognostic data of FFRCT. The registry data has demonstrated FFRCT as a comparable indicator of cardiac prognosis to invasive fractional flow reserve. Future research areas include the use of FFRCT to plan coronary revascularisation prior to procedures and even perhaps to predict future cardiac event using computational flow dynamic data. Summary FFRCT is now an established technology for the diagnosis of coronary artery disease with increasing use in clinical practice. The potential of the technology to deliver cost savings, improved triage and more directed management will depend upon the manner of its use. Future applications of the principles of FFRCT have broad potential for improved understanding of coronary artery disease and superior management of patients afflicted with it. Keywords Cardiac CT . Non-invasive fractional flow reserve . Fractional flow reserve . Stable angina . FFRCT . Chest pain
Introduction Coronary artery disease (CAD) remains a leading cause of death and morbidity around the world [1]. Management of the condition broadly includes lifestyle modification, medical therapies, percutaneous coronary interventions (PCI) or coronary artery bypass surgery (CABG). As such, appropriate identification of patients with significant coronary artery disease is required to guide appropriate choice of treatment. The diagnostic approach to coronary artery disease has shifted dramatically in recent years from an invasive approach to a noninvasive one [2]. Computer tomography coronary This article is part of the Topical Collection on Cardiac Computed Tomography * Alex Asher [email protected] 1
Department of Cardiology, St. Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
angiography (CTCA) has excellent sensitivity for the detection of coronary artery disease [3]. Moreover, the reliance of stress testing or perfusion imaging on presence of ischaemia to diagnose coronary artery disease and the growing appreciation that CT-guide
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