Fractional Flow Reserve from Coronary CT: Evidence, Applications, and Future Directions

Authors

Arta Kasaeian
Mohadese Ahmadzade
Taylor Hoffman
Mohammad Ghasemi-Rad
Anoop Padoor Ayyappan

Language

English

Publication Date

7-22-2025

Journal

Journal of Cardiovascular Development and Disease

DOI

10.3390/jcdd12080279

PMID

40863345

PMCID

PMC12386757

PubMedCentral® Posted Date

7-22-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Coronary computed tomography angiography (CCTA) has emerged as the leading noninvasive imaging modality for the assessment of coronary artery disease (CAD), offering high-resolution visualization of the coronary anatomy and plaque characterization. The development of fractional flow reserve derived from CCTA (FFR-CT) has further transformed the diagnostic landscape by enabling the simultaneous evaluation of both anatomical stenosis and lesion-specific ischemia. FFR-CT has demonstrated diagnostic accuracy comparable to invasive FFR. The combined use of CCTA and FFR-CT is now pivotal in a broad range of clinical scenarios, including the evaluation of stable and acute chest pain, assessment of high-risk and complex plaque features, and preoperative planning. As evidence continues to mount, CCTA and FFR-CT are positioned to become the primary gatekeepers to the cardiac catheterization laboratory, potentially reducing the number of unnecessary invasive procedures. This review highlights the growing clinical utility of FFR-CT, its integration with advanced plaque imaging, and the future potential of these technologies in redefining the management of CAD, while also acknowledging current limitations, including image quality requirements, cost, and access.

Published Open-Access

yes

Recommended Citation

Kasaeian, Arta; Ahmadzade, Mohadese; Hoffman, Taylor; et al., "Fractional Flow Reserve from Coronary CT: Evidence, Applications, and Future Directions" (2025). Faculty, Staff and Students Publications. 3785.
https://digitalcommons.library.tmc.edu/baylor_docs/3785