Coronary computed tomography angiography derived flow fractional reserve: the state of the art

Abstract

Coronary computed tomographic angiography (CCTA) is an effective examination with high sensitivity to rule out obstructive coronary artery disease (CAD). It can provide anatomical information of coronary artery disease, such as the degree of stenosis, plaque characteristics, but has poor discriminatory power for hemodynamically significant lesions, which may lead to unnecessary referrals for invasive coronary angiography (ICA). Invasive fractional flow reserve (FFR) is generally considered as the gold standard for the functional evaluation of CAD. However, high cost and invasive characteristics of FFR limit its wide clinical application. Recently, non-invasive CT-derived fractional flow reserve (CT-FFR), a novel image post-processing technique combining the advantages of CCTA and FFR, allows us to obtain both anatomic and functional information of a coronary lesion. CT-FFR has been used in diagnosing and guiding clinical management of CAD patients. This review introduces the basic principles, key points of CT-FFR analysis, and current research progress of CT-FFR.