Fractional Flow Reserve Derived from Coronary Computed Tomography the Next Frontier in Non-Invasive Assessment of Coronary Artery Disease

Purpose: Evaluate the diagnostic performance of Coronary Computed Tomography Angiography (CCTA) derived fractional flow reserve (CT-FFR) with invasive fractional flow reserve (FFR) in patients with coronary artery disease CAD, serving as the reference standard.

CT-FFR is a novel technology that enables determination of the functional significance of lesions noninvasively, using sophisticated computer algorithms (Frontier Research Software) based on computational fluid dynamics applied to coronary CCTA. There is evidence studies, comparing CT-FFR with invasive FFR (representing the gold standard), that CT-FFR can be helpful in the evaluation of hemodynamic significance of stenosis, especially in patients with intermediate severity stenosis.

Methods: 29 patients were prospectively enrolled (age: 66, male: 76%). Patients underwent CCTA and invasive coronary angiography (ICA) with FFR in 30 lesions. CCTA, and CT-FFR were interpreted by independent and experiment radiologists Stenosis severity according to coronary CCTA and ICA stenosis ≥50% was considered anatomically obstructive. Lesion-specific ischemia was defined according to FFR ≤0.8.

Results: According to FFR, ischemia was present in 31% of lesions. Sensitivity 90%, specificity 77.8%, positive predictive value 69.23 %, negative predictive value 93.33 %, P

Conclusion: The analysis showed that CT-FFR had a high diagnostic accuracy in determining ischemia-specific lesions and intermediate lesions. There was no significant difference when comparing the combined diagnostic performance CT-FFR with invasive FFR as the reference standard.