CT Fractional Flow Reserve for Stable Coronary Artery Disease: The Ongoing Journey.
Radiology. 2018 Apr;287(1):85-86. doi: 10.1148/radiol.2018172838. Leipsic JA1, Hurwitz Koweek L1.
For years, the field of cardiology focused on anatomic stenosis to guide clinical decision making regarding the need for coronary intervention. However, recent registry and randomized multicenter trials have highlighted the incremental value of both fractional flow reserve (FFR) (1) and instantaneous wave free ratio (2) to adjudicate lesion-specific ischemia for anatomic coronary artery stenosis and to guide revascularization decision making. This has been shown to result in improved clinical outcomes when compared with both angiographic-guided revascularization and optimal medical therapy (1,2). The recent introduction of FFR derived noninvasively from cardiac computed tomographic (CT) angiography FFR has opened the door to a noninvasive means to generate coronary artery pressure maps in parallel to invasive FFR determination. CT FFR has significantly improved the diagnostic performance of CT angiography by enabling the determination of lesion-specific ischemia for intermediate- and high-grade stenoses while substantially enriching the population in the coronary catheterization laboratory with both safe deferral and augmentation of the percutaneous coronary intervention to invasive coronary angiography ratio across numerous health care environments (3–5).