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

Fractional flow reserve (FFR) derived from coronary CTA datasets (FFR(CT)) 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(CT) values are obtained using resting 3D coronary CTA images using computational fluid dynamics. Several multicenter clinical trials have demonstrated the diagnostic superiority of FFR(CT) over traditional coronary CTA for the diagnosis of functionally significant coronary artery disease. This review provides a background of FFR, technical aspects of FFR(CT), clinical applications and interpretation of FFR(CT) values, clinical trial data, and future directions of the technology.