Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Datasets: The Next Frontier in Noninvasive Assessment of Coronary Artery Disease

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2018 Oct 3

PMID 30276202

Citations 12

Authors

Caroline Ball

Gianluca Pontone

Mark Rabbat

Affiliations

Soon will be listed here.

Abstract

Fractional flow reserve (FFR) derived from coronary CTA datasets (FFR) is a major advance in cardiovascular imaging that provides critical information to the Heart Team without exposing the patient to excessive risk. Previously, invasive FFR measurements obtained during a cardiac catheterization have been demonstrated to reduce contrast use, number of stents, and cost of care and improve outcomes. However, there are barriers to routine use of FFR in the cardiac catheterization suite. FFR values are obtained using resting 3D coronary CTA images using computational fluid dynamics. Several multicenter clinical trials have demonstrated the diagnostic superiority of FFR over traditional coronary CTA for the diagnosis of functionally significant coronary artery disease. This review provides a background of FFR, technical aspects of FFR, clinical applications and interpretation of FFR values, clinical trial data, and future directions of the technology.

Citing Articles

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References

Toth G, Hamilos M, Pyxaras S, Mangiacapra F, Nelis O, De Vroey F . Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J. 2014; 35(40):2831-8. DOI: 10.1093/eurheartj/ehu094. View

Renker M, Schoepf U, Wang R, Meinel F, Rier J, Bayer 2nd R . Comparison of diagnostic value of a novel noninvasive coronary computed tomography angiography method versus standard coronary angiography for assessing fractional flow reserve. Am J Cardiol. 2014; 114(9):1303-8. DOI: 10.1016/j.amjcard.2014.07.064. View

Chinnaiyan K, Akasaka T, Amano T, Bax J, Blanke P, De Bruyne B . Rationale, design and goals of the HeartFlow assessing diagnostic value of non-invasive FFR in Coronary Care (ADVANCE) registry. J Cardiovasc Comput Tomogr. 2016; 11(1):62-67. DOI: 10.1016/j.jcct.2016.12.002. View

Neglia D, Rovai D, Caselli C, Pietila M, Teresinska A, Aguade-Bruix S . Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circ Cardiovasc Imaging. 2015; 8(3). DOI: 10.1161/CIRCIMAGING.114.002179. View

Lee J, Choi G, Koo B, Hwang D, Park J, Zhang J . Identification of High-Risk Plaques Destined to Cause Acute Coronary Syndrome Using Coronary Computed Tomographic Angiography and Computational Fluid Dynamics. JACC Cardiovasc Imaging. 2018; 12(6):1032-1043. DOI: 10.1016/j.jcmg.2018.01.023. View

Koo B, Erglis A, Doh J, Daniels D, Jegere S, Kim H . Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained.... J Am Coll Cardiol. 2011; 58(19):1989-97. DOI: 10.1016/j.jacc.2011.06.066. View

Norgaard B, Leipsic J, Gaur S, Seneviratne S, Ko B, Ito H . Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014; 63(12):1145-1155. DOI: 10.1016/j.jacc.2013.11.043. View

Pontone G, Muscogiuri G, Andreini D, Guaricci A, Guglielmo M, Baggiano A . Impact of a New Adaptive Statistical Iterative Reconstruction (ASIR)-V Algorithm on Image Quality in Coronary Computed Tomography Angiography. Acad Radiol. 2018; 25(10):1305-1313. DOI: 10.1016/j.acra.2018.02.009. View

Min J, Leipsic J, Pencina M, Berman D, Koo B, Van Mieghem C . Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA. 2012; 308(12):1237-45. PMC: 4281479. DOI: 10.1001/2012.jama.11274. View

10.

Kueh S, Mooney J, Ohana M, Kim U, Blanke P, Grover R . Fractional flow reserve derived from coronary computed tomography angiography reclassification rate using value distal to lesion compared to lowest value. J Cardiovasc Comput Tomogr. 2017; 11(6):462-467. DOI: 10.1016/j.jcct.2017.09.009. View

11.

Meyersohn N, Szilveszter B, Staziaki P, Scholtz J, Takx R, Hoffmann U . Coronary CT angiography in the emergency department utilizing second and third generation dual source CT. J Cardiovasc Comput Tomogr. 2017; 11(4):249-257. PMC: 5963691. DOI: 10.1016/j.jcct.2017.03.002. View

12.

de Bruyne B, Hersbach F, Pijls N, Bartunek J, Bech J, Heyndrickx G . Abnormal epicardial coronary resistance in patients with diffuse atherosclerosis but "Normal" coronary angiography. Circulation. 2001; 104(20):2401-6. DOI: 10.1161/hc4501.099316. View

13.

Dattilo P, Prasad A, Honeycutt E, Wang T, Messenger J . Contemporary patterns of fractional flow reserve and intravascular ultrasound use among patients undergoing percutaneous coronary intervention in the United States: insights from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2012; 60(22):2337-9. DOI: 10.1016/j.jacc.2012.08.990. View

14.

Pontone G, Andreini D, Guaricci A, Guglielmo M, Mushtaq S, Baggiano A . Rationale and design of the PERFECTION (comparison between stress cardiac computed tomography PERfusion versus Fractional flow rEserve measured by Computed Tomography angiography In the evaluation of suspected cOroNary artery disease) prospective.... J Cardiovasc Comput Tomogr. 2016; 10(4):330-4. DOI: 10.1016/j.jcct.2016.03.004. View

15.

Taylor C, Gaur S, Leipsic J, Achenbach S, Berman D, Jensen J . Effect of the ratio of coronary arterial lumen volume to left ventricle myocardial mass derived from coronary CT angiography on fractional flow reserve. J Cardiovasc Comput Tomogr. 2017; 11(6):429-436. DOI: 10.1016/j.jcct.2017.08.001. View

16.

Meijboom W, van Mieghem C, Van Pelt N, Weustink A, Pugliese F, Mollet N . Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol. 2008; 52(8):636-43. DOI: 10.1016/j.jacc.2008.05.024. View

17.

Hlatky M, De Bruyne B, Pontone G, Patel M, Norgaard B, Byrne R . Quality-of-Life and Economic Outcomes of Assessing Fractional Flow Reserve With Computed Tomography Angiography: PLATFORM. J Am Coll Cardiol. 2015; 66(21):2315-2323. DOI: 10.1016/j.jacc.2015.09.051. View

18.

Johnson N, Gould K, Di Carli M, Taqueti V . Invasive FFR and Noninvasive CFR in the Evaluation of Ischemia: What Is the Future?. J Am Coll Cardiol. 2016; 67(23):2772-2788. DOI: 10.1016/j.jacc.2016.03.584. View

19.

Ko B, Cameron J, Munnur R, Wong D, Fujisawa Y, Sakaguchi T . Noninvasive CT-Derived FFR Based on Structural and Fluid Analysis: A Comparison With Invasive FFR for Detection of Functionally Significant Stenosis. JACC Cardiovasc Imaging. 2016; 10(6):663-673. DOI: 10.1016/j.jcmg.2016.07.005. View

20.

Douglas P, De Bruyne B, Pontone G, Patel M, Norgaard B, Byrne R . 1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study. J Am Coll Cardiol. 2016; 68(5):435-445. DOI: 10.1016/j.jacc.2016.05.057. View