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

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Abstract

Fractional flow reserve (FFR) measured during invasive coronary angiography is the gold standard for lesion-specific decisions on coronary revascularization in patients with stable coronary artery disease (CAD). Current guidelines recommend non-invasive functional or anatomic testing as a gatekeeper to the catheterization laboratory. However, the “holy grail” in non-invasive testing of CAD is to establish a single test that quantifies both coronary lesion severity and the associated ischemia. Most evidence to date of such a test is based on the addition of computational analysis of FFR to the anatomic information obtained from standard-acquired coronary CTA data sets at rest (FFRCT). This review summarizes the clinical evidence for the use of FFRCT in stable CAD in context to the diagnostic performance of other non-invasive testing modalities.

Key Points

The process of selecting appropriate patients for invasive coronary angiography is inadequate

Invasive fractional flow reserve is the standard for assessing coronary lesion-specific ischemia

Fractional flow reserve may be derived from standard coronary CT angiography (FFR CT )

FFR CT provides high diagnostic performance in stable coronary artery disease

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

CAD:

Coronary artery disease

CTA:

Computed tomography angiography

CTP:

Computed tomography perfusion

CMR:

Magnetic resonance myocardial perfusion imaging

FFR:

Fractional flow reserve

FFRCT :

Fractional flow reserve derived from coronary computed tomography angiography

ICA:

Invasive coronary angiography

NPV:

Negative predictive value

PPV:

Positive predictive value

SPECT:

Single photon emission computed tomography

TAG:

Transluminal attenuation gradient

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Acknowledgments

The scientific guarantor of this publication is Hans Erik Botker (heb@dadlnet.dk). The authors of this manuscript declare relationships with the following companies: GE Healthcare, HeartFlow, Siemens, and Edwards Lifesciences. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval and written informed consent was not required for this study because this was a retrospective review. Some study subjects or cohorts have been previously reported. Methodology: review.

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Correspondence to B. L. Nørgaard.

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Nørgaard, B.L., Jensen, J.M. & Leipsic, J. Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing?. Eur Radiol 25, 2282–2290 (2015). https://doi.org/10.1007/s00330-015-3619-1

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