Kasaeian Arta, Ahmadzade Mohadese, Hoffman Taylor, Ghasemi-Rad Mohammad, Ayyappan Anoop Padoor
Baylor College of Medicine, Houston, TX 77030, USA.
Department of Radiology, Division of Vascular and Interventional Radiology, Baylor College of Medicine, Houston, TX 77030, USA.
J Cardiovasc Dev Dis. 2025 Jul 22;12(8):279. doi: 10.3390/jcdd12080279.
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.
冠状动脉计算机断层扫描血管造影（CCTA）已成为评估冠状动脉疾病（CAD）的主要非侵入性成像方式，能够对冠状动脉解剖结构进行高分辨率可视化并对斑块进行特征描述。基于CCTA的血流储备分数（FFR-CT）的发展进一步改变了诊断格局，它能够同时评估解剖学狭窄和病变特异性缺血情况。FFR-CT已证明其诊断准确性与有创FFR相当。目前，CCTA和FFR-CT的联合应用在广泛的临床场景中至关重要，包括对稳定型和急性胸痛的评估、高危和复杂斑块特征的评估以及术前规划。随着证据不断增加，CCTA和FFR-CT有望成为心脏导管实验室的主要把关手段，有可能减少不必要的有创检查数量。本综述强调了FFR-CT日益增长的临床应用价值、其与先进斑块成像的整合以及这些技术在重新定义CAD管理方面的未来潜力，同时也承认当前存在的局限性，包括图像质量要求、成本和可及性。
