Integration of fractional flow reserve derived from CT into clinical practice.

Fractional flow reserve (FFR) is currently considered as the gold standard for revascularization decision-making in patients with stable coronary artery disease (CAD). The application of computational fluid dynamics to coronary computed tomography (CT) angiography (CCTA) enables calculation of FFR without additional testing, radiation exposure, contrast medium injection, and hyperemia (FFR CT). Although multiple diagnostic and clinical studies have enriched the scientific evidence, it is still challenging to integrate FFR CT into clinical practice. Both meticulous scientific backgrounds and precise anatomical data derived from CCTA are fundamental for FFR CT computation, and there are numerous factors impacting on FFR CT calculation and interpretation: coronary artery stenosis, calcium, atherosclerosis, luminal volume, and left ventricular myocardial mass. Further, there is a gap that clinicians using FFR CT need to recognize in interpretation of FFR CT results between diagnostic studies and clinical studies. In this review, we summarize multiple evidence related to FFR CT computation and interpretation to refine the FFR CT strategy in patients with stable CAD. [Display omitted] • Fractional flow reserve (FFR) is the gold standard for revascularization in patients with stable coronary artery disease. • Application of computational fluid dynamics to computed tomography (CT) enables non-invasive calculation of FFR (FFR CT). • Numerous factors impact on FFR CT calculation as well as invasive FFR. • There is a gap in interpretation of FFR CT results between diagnostic studies and clinical studies. [ABSTRACT FROM AUTHOR]