Division of Cardiology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Division of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Curr Cardiol Rev. 2023;19(4):e190123212887. doi: 10.2174/1573403X19666230119115228.
Coronary artery disease is the leading cause of mortality worldwide. Diagnosis is conventionally performed by direct visualization of the arteries by invasive coronary angiography (ICA), which has inherent limitations and risks. Measurement of fractional flow reserve (FFR) has been suggested for a more accurate assessment of ischemia in the coronary artery with high accuracy for determining the severity and decision on the necessity of intervention. Nevertheless, invasive coronary angiography-derived fractional flow reserve (ICA-FFR) is currently used in less than one-third of clinical practices because of the invasive nature of ICA and the need for additional equipment and experience, as well as the cost and extra time needed for the procedure. Recent technical advances have moved towards non-invasive high-quality imaging modalities, such as magnetic resonance, single-photon emission computed tomography, and coronary computed tomography (CT) scan; however, none had a definitive modality to confirm hemodynamically significant coronary artery stenosis. Coronary computed tomography angiography (CCTA) can provide accurate anatomic and hemodynamic data about the coronary lesion, especially calculating fractional flow reserve derived from CCTA (CCTA-FFR). Although growing evidence has been published regarding CCTA-FFR results being comparable to ICA-FFR, CCTA-FFR has not yet replaced the invasive conventional angiography, pending additional studies to validate the advantages and disadvantages of each diagnostic method. Furthermore, it has to be identified whether revascularization of a stenotic lesion is plausible based on CCTA-FFR and if the therapeutic plan can be determined safely and accurately without confirmation from invasive methods. Therefore, in the present review, we will outline the pros and cons of using CCTA-FFR vs. ICA-FFR regarding diagnostic accuracy and treatment decision-making.
冠心病是全球范围内导致死亡的主要原因。传统上通过有创性冠状动脉造影（ICA）直接观察动脉来进行诊断，但该方法存在固有局限性和风险。测量血流储备分数（FFR）已被建议用于更准确地评估冠状动脉的缺血情况，其对确定严重程度和决定是否需要介入治疗具有很高的准确性。然而，由于 ICA 的侵袭性以及对额外设备和经验的需求，以及该程序所需的成本和额外时间，目前只有不到三分之一的临床实践使用基于 ICA 的血流储备分数（ICA-FFR）。最近的技术进步已经朝着非侵入性的高质量成像方式发展，例如磁共振成像、单光子发射计算机断层扫描和冠状动脉计算机断层扫描（CT）扫描；然而，没有一种方法可以明确证实具有血流动力学意义的冠状动脉狭窄。冠状动脉 CT 血管造影（CCTA）可以提供有关冠状动脉病变的准确解剖和血流动力学数据，特别是计算来自 CCTA 的血流储备分数（CCTA-FFR）。尽管已经发表了越来越多关于 CCTA-FFR 结果与 ICA-FFR 相当的证据，但在进一步研究验证每种诊断方法的优缺点之前，CCTA-FFR 尚未取代有创的常规血管造影。此外，还必须确定基于 CCTA-FFR 对狭窄病变进行血运重建是否合理，以及是否可以安全准确地确定治疗计划，而无需通过有创方法进行确认。因此，在本综述中，我们将概述使用 CCTA-FFR 与 ICA-FFR 在诊断准确性和治疗决策方面的优缺点。
