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Opportunities and challenges of implementing computed tomography fractional flow reserve into clinical practice

Research output: Contribution to journalReview article

Muhummad Sohaib Nazir, Tarun K. Mittal, Jonathan Weir-Mccall, Koen Nieman, Keith Channon, Edward D. Nicol

Original languageEnglish
Article numberheartjnl-2019-315607
Pages (from-to)1387-1393
Number of pages7
JournalHeart
Volume106
Issue number18
DOIs
Accepted/In press1 Jan 2020
Published1 Sep 2020

King's Authors

Abstract

CT-derived fractional flow reserve (CT-FFR) uses computational fluid dynamics to derive non-invasive FFR to determine the haemodynamic significance of coronary artery lesions. Studies have demonstrated good diagnostic accuracy of CT-FFR and reassuring short-term clinical outcome data. As a prerequisite, high-quality CT coronary angiography (CTCA) images are required with good heart rate control and pre-treatment with glyceryl trinitrate, which would otherwise render CTCA as unsuitable for CT-FFR. CT-FFR can determine the functional significance of CAD lesions, and there are supportive data for its use in clinical decision-making. However, the downstream impact on myocardial ischaemic burden or viability cannot be obtained. Several challenges remain with implementation of CT-FFR, including interpretation, training, availability, resource utilisation and funding. Further research is required to determine which cases should be considered for clinical CT-FFR analysis, with additional practical guidance on how to implement this emerging technique in clinical practice. Furthermore, long-term prognostic data are required before widespread clinical implementation of CT-FFR can be recommended. While there are several potential opportunities for CT-FFR, at present there remain important systemic and technical limitations and challenges that need to be overcome prior to routine integration of CT-FFR into clinical practice.

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