Links To And Excerpts From Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting

In this post I link to and excerpt from Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Radiol Cardiothorac Imaging. 2019 Nov 21;1(5):e190050. doi: 10.1148/ryct.2019190050. eCollection 2019 Dec.

All that follows is from the above article:

Abstract

Noninvasive fractional flow reserve derived from coronary CT angiography (FFR_CT) is increasingly used in patients with coronary artery disease as a gatekeeper to the catheterization laboratory. While there is emerging evidence of the clinical benefit of FFR_CT in patients with moderate coronary disease as determined with coronary CT angiography, there has been less focus on interpretation, reporting, and integration of FFR_CT results into routine clinical practice. Because FFR_CT analysis provides a plethora of information regarding pressure and flow across the entire coronary tree, standardized criteria on interpretation and reporting of the FFR_CT analysis result are of crucial importance both in context of the clinical adoption and in future research. This report represents expert opinion and recommendation on a standardized FFR_CT interpretation and reporting approach.

Keywords: Adults, CT-Angiography, Coronary Arteries, Fractional Flow Reserve, Heart

Published under a CC BY 4.0 license.

Summary

Expert opinion and recommendation was given by an independent group of physicians on a standardized interpretation and reporting approach for CT-derived fractional flow reserve testing supported by years of clinical experience.

Key Points

•  Standardized criteria on interpretation and reporting of CT-derived fractional flow reserve (FFR_CT) analysis results are of importance both in context of their clinical adoption and in future research.

• Use of the FFR_CT value 10–20 mm distal to the lower border of the stenosis for decision making is recommended.

• We recommend for clinical decision making a dichotomous interpretation strategy to be considered only in lesions with FFR_CT greater than 0.80 or lower than or equal to 0.75, whereas, in patients with FFR_CT ranging between 0.76 and 0.80, additional risk stratification information is needed.

• The results of FFR_CT must be evaluated in their clinical context, taking into account patient symptoms, the coronary anatomy, and suitability of revascularization.