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 (FFRCT). Although multiple diagnostic and clinical studies have enriched the scientific evidence, it is still challenging to integrate FFRCT into clinical practice. Both meticulous scientific backgrounds and precise anatomical data derived from CCTA are fundamental for FFRCT computation, and there are numerous factors impacting on FFRCT calculation and interpretation: coronary artery stenosis, calcium, atherosclerosis, luminal volume, and left ventricular myocardial mass. Further, there is a gap that clinicians using FFRCT need to recognize in interpretation of FFRCT results between diagnostic studies and clinical studies. In this review, we summarize multiple evidence related to FFRCT computation and interpretation to refine the FFRCT strategy in patients with stable CAD.