Noninvasive Assessment of Coronary Artery Disease: Fractional Flow Reserved Derived from Coronary Computed Tomography Angiography (FFRCT)

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Invasive coronary angiography (ICA) completed by fractional flow reserve (FFR) assessment represents the main procedure that is performed in the decision process for coronary revascularization. Coronary Computed Tomography Angiography (CCTA) is an effective method used in the noninvasive anatomic assessment of coronary artery disease (CAD). However, CCTA tends to overestimate and does not offer hemodynamic data about the coronary lesions. Recent progresses made in the research involving computational fluid dynamics and image modeling permit the evaluation of FFRCT noninvasively, using data obtained in a standard CCTA. Studies have shown an improved precision and discrimination of FFRCT compared to CCTA for the diagnosis of significant coronary artery stenosis. In this review, we aimed to summarize the role of CCTA in CAD evaluation, the impact of FFRCT, the scientific basis of this novel method and its potential clinical applications.

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  • 1. Nichols M Townsend N Scarborough P et al. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35:2920-2929.

  • 2. Norgaard BL Leipsic J Koo BK et al. Coronary Computed Tomography Angiography Derived Fractional Flow Reserve and Plaque Stress. Curr Cardiovasc Rep. 2016;9:2.

  • 3. Lucas FL Siewers AE Malenka DJ et al. Diagnostic-therapeutic cascade revisited: coronary angiography coronary artery bypass graft surgery and percutaneous coronary intervention in the modern era. Circulation. 2008;118:2797-2802.

  • 4. Grunau GL Min JK Leipsic J. Modeling of Fractional Flow Reserve Based on Coronary CT Angiography. Curr Cardiol Rep. 2013;15:336.

  • 5. Tonino PA Faeron WF DeBruyne B et al. Angiographic versus functional severity of coronary artery stenosis in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010;55(25):2816-2821.

  • 6. Metz LD Beattie M Hom R et al. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol. 2007;49:227-237.

  • 7. Gould KL Lipscomb K Hamilton GW. Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during xoronary hyperemia as measures of coronary flow reserve. Am J Cardiol. 1974;33:87-94.

  • 8. Uren NG Melin JA De Bruyne B et al. Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med. 1994;330(25):1782-1788.

  • 9. Abd TT George RT. Association of coronary plaque burden with fractional flow reserve: should we keep attempting to drive physiology from anatomy? Cardiovasc Diagn Ther. 2015;5(1):67-70.

  • 10. Fihn SD Gardin JM Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the ACCF AHA ACP AATS PCNA SCAI STS. J Am Coll Cardiol. 2012;60(24):44-164.

  • 11. Pijls NH Sels JW. Functional Measurment of Coronary Stenosis. J Am Coll Cardiol. 2012;59(12):1045-1057.

  • 12. Pang CL Alcock R Pilkington N et al. Determining the haemodynamic significance of arterial stenosis: the relationship between CT angiography computational fluid dynamics and noninvasive fractional flow reserve. Clin Radiol. 2016;71(8):750-757.

  • 13. Pijls NH van Son JA Kirkeeide RL et al. Experimental basis of determining maximum coronary myocardial and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation. 1993;87(4):1354-1367.

  • 14. Pijls NH van Schaardenburgh Manoharan G et al. Percunateous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER study. J Am Coll Cardiol. 2007;49(21):2105-2111.

  • 15. Boden WE O’Rouuke RA Teo KK et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516.

  • 16. Pijls NH De Bruyene B Peels K et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996;334(26):1703-1708.

  • 17. Fearon WF Bornschein B Tonino PA et al. Economic evaluation of fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. Circulation. 2010;122(24):2545-2550.

  • 18. Budoff MJ Shinbane JS. Cardiac CT Imaging: Diagnosis of Cardiovascular Disease – Third Edition. London. Springer-Verlag. 2016.

  • 19. Benedek I Benedek T. Multislice Angio Computed Tomography in the Diagnosis of Cardiovascular Diseases. Oradea. Editura Universitatii din Oradea. 2014

  • 20. Benedek I Chitu M Kovacs I et al. Incremental value of preporcedural Coronary Computed Tomographic Angiography to classical Coronary Angiography for prediction of PCI complexity in left main stenosis. World J Cardiovasc Dis. 2013;3(9):537-580.

  • 21. Stahli BE Bonassin F Goetti R et al. Coronary Computed Tomography Angiography Indicates Complexity of Percutaneous Coronary Interventions. J Invasive Cardiol. 2012;24(5):196-201.

  • 22. Heydari B Leipsic J Mancini GB et al. Diagnostic performance of high-definition coronary computed tomography angiography performed with multiple radiation dose reduction strategies. Can J Cardiol. 2011;27:606-612.

  • 23. Nakazato R Otake H Konishi A et al. Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: a comparison to optical coherence tomography. Eur Heart J Cardiovasc Imaging. 2015;16(4):373-379.

  • 24. Cheruvu C Naoum C Blanke P et al. Beyond Stenosis With Fractional Flow Reserve Via Computed Tomography and Advanced Plaque Analyses for the Diagnosis of Lesion-Specific Ischemia. Can J Cardiol. 2016;28(16):63-65.

  • 25. Hamon M Biondi-Zoccai GG Malagutti P et al. Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-anatylis. J Am Coll Cardiol. 2006;48:1896-1910.

  • 26. Kochar M Min JK. Physiologic assessment of coronary artery disease by cardiac computed tomography. Korean Circ J. 2013;43(7):435-442.

  • 27. Zarins CK Taylor CA Min JK. Computed fractional flow reserve (FFRCT) derivated from coronary CT angiography. J Cardiovasc Transl Res. 2013;6(5):708-714.

  • 28. Taylor CA Fonte TA Min JK. Computational Fluid Dynamics Applied to Cardiac Computed Tomography for Noninvasive Quantification of Fractional Flow Reserve. J Am Coll Cardiol. 2013;61(22):2233-2241.

  • 29. Koo BK Erglis A Doh JH et al. Diagnosis of Ischemia-Causing Coronary Stenoses by Noninvasive Fractional Flow Reserve Computed From Coronary Computed Tomographic Angiograms. Results from the Prospective Multicenter DISCOVER-FLOW Study. J Am Coll Cardiol. 2011;58(19):1989-1997.

  • 30. Nakazato R Park HB Berman DS et al. Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity: results from the DeFACTO study. Circ Cardiovasc Imaging. 2013;6(6):881-889.

  • 31. Gaur S Achenbach S Leipsic J et al. Rationale and design of the HeartFlowNXT study. J Cardiovasc Comput Tomogr. 2013;7(5):279-288.

  • 32. Norgraard BL Gaur S Leipsic J et al. Influence of Coronary Calcification on the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: A Substudy of the NXT Trial. Jacc Cardiovasc Imaging. 2015;8(9):1045-1055.

  • 33. Hlatky MA De Bruyne B Pontone G et al. 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.

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