New Consensus Statement Standardizes Use of CT-Derived FFR
ARLINGTON, VA — The Society of Cardiovascular Computed Tomography (SCCT), in collaboration with the Society for Cardiovascular Angiography and Interventions (SCAI), released an expert consensus document on the use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR-CT) for assessing coronary artery disease (CAD).
Published in the Journal of Cardiovascular Computed Tomography (JCCT) and endorsed by the American College of Cardiology (ACC), “Fractional flow reserve in coronary computed tomography angiography” provides evidence-based guidelines for the acquisition, interpretation and reporting of FFR-CT, emphasizing its role in improving diagnostic accuracy, guiding clinical management and reducing unnecessary invasive procedures.
According to writing group co-chairs Jonathan Weir-McCall, MBChB, PhD, FSCCT and Ronak Rajani, MD, PhD, FSCCT, this collaboration took almost 5 years of planning, which they credit to the extensive thought and consideration that goes into collaborative consensus documents.
"It was felt that the literature had reached a state of maturity where we could start to provide guidelines to the wider community that were based on what the evidence suggests we should do,” said Dr. Weir-McCall.
He explained that FFR-CT was also becoming a more commonly used tool in community hospitals and is “reaching out across the globe,” creating this need to standardize practice and provide a framework for the optimal acquisition of CCTA for the use of FFR-CT, appropriate selection of cases for FFR-CT usage, interpretation and reporting of outputs.
According to the writing group, FFR-CT enhances the diagnostic and prognostic capabilities of CCTA by incorporating physiological significance into anatomical assessments, noting that its structured use can improve patient outcomes, reduce invasive procedures and optimize clinical decision-making. They said continued advancements in technology and research are expected to expand its clinical utility further.
The consensus document outlines recommendations for acquisition; diagnostic accuracy; clinical applications including stable chest pain, multivessel disease, acute chest pain and special circumstances; prognostic value; reporting and future directions.
Top takeaways from the co-chairs include:
High-quality CCTA imaging is essential for accurate FFR-CT computation. The use of nitroglycerin and heart rate control also improve diagnostic accuracy, and that motion artifacts and calcification can impact FFR-CT reliability.
The biggest role for FFR-CT is in patients with stable chest pain and assessing intermediate stenosis to guide revascularization decisions.
FFR-CT values should be integrated into CCTA reports, with stenosis-specific values measured 2 cm distal to the lesion. “The 2cm distal to the lesion seems to have the most robust evidence base, not only in terms of clinical outcomes but also in longer term prognosis,” Dr. Rajani said.
About the Society of Cardiovascular Computed Tomography
Founded in 2005, the Society of Cardiovascular Computed Tomography (SCCT) is the international professional society devoted to improving health outcomes through effective use of cardiovascular computed tomography (CCT). SCCT is a community of physicians, scientists and technologists from over 100 countries advocating for access, research, education and clinical excellence in the use of CCT. For more information, please visit https://scct.org.
About the Journal of Cardiovascular Computed Tomography
The Journal of Cardiovascular Computed Tomography (JCCT) is a peer-review journal of the SCCT that integrates the international cardiovascular CT community and addresses a broad range of topics affecting cardiovascular CT imaging. The journal’s major focus is on original research and on the clinical and technical aspects of cardiovascular CT. For more information, please visit www.journalofcardiovascularct.com.
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