2021 Volume 51 Issue 2 Pages 83-88
Coronary computed tomography (CT) is useful for the diagnosis of stable angina pectoris, and its high diagnostic accuracy for the detection of significant coronary artery stenosis has been identified in many previous studies. The effectiveness of utilizing CT in detecting myocardial ischemia by evaluating the perfusion of the left ventricular myocardium has also been reported, but it is not being widely used in daily clinical practice because of its difficulty.
Recently, the fractional flow reserve (FFR) versus angiography for multi-vessel evaluation (FAME) trial revealed that the prognosis was significantly higher for the patients who underwent coronary artery revascularization therapy (CART) based on FFR than for those who underwent CART based on the visual assessment of significant stenosis. Several studies on coronary angiography have reported a difference between the visually and functionally significant coronary stenosis i.e. degree of stenosis detected visually may not be the same as that shown by the FFR. We are now able to evaluate FFR using the new computational fluid dynamics software by analyzing the normal coronary CT data. The diagnostic accuracy of this FFR on CT is relatively high when compared with invasive FFR measured by coronary angiography, which is the current gold standard. Evaluation of functionally significant coronary artery stenosis on CT has the potential to reduce unnecessary invasive coronary angiographies without increase in the number cardiac events (which may occur owing to misdiagnosis based on the FFR-CT analysis), as reported by some recent clinical studies. By using this software, we can also predict what the new FFR value would be after the coronary arteries have undergone revascularization via percutaneous coronary artery intervention or coronary artery bypass grafting. In this article, we would like to introduce the clinical utility of measuring FFR using CT and its future perspectives to the clinicians.
