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Circ Cardiovasc Interv 2022 Jun 23;15(6):e011948. Epub 2022 May 23.

Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Spain (H.M.R., J.E.).

Background: Coronary pressure indices such as fractional flow reserve are the standard for guiding elective revascularization. However, considering additional coronary flow parameters could further individualize and optimize the decision on revascularization. We aimed to investigate the potentially differential prognostic associations of elective percutaneous coronary intervention (PCI) according to coronary flow properties represented by coronary flow reserve (CFR), coronary flow capacity (CFC), and baseline CFC (bCFC). Read More

JACC Cardiovasc Interv 2022 May;15(10):1047-1056

Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.

Objectives: The aim of this study was to demonstrate the clinical implications of combined assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR).

Background: Combined assessment of FFR and CFR allows detailed characterization of pathophysiology in chronic coronary syndromes. Data on the clinical implications of distinct FFR and CFR patterns are limited, leading to uncertainty regarding their relevance. Read More

J Cardiovasc Comput Tomogr 2022 Mar 28. Epub 2022 Mar 28.

Cleerly, Inc., Denver, CO, USA; George Washington University School of Medicine, Washington, DC, USA. Electronic address:

Background: Atherosclerotic plaque characterization by coronary computed tomography angiography (CCTA) enables quantification of coronary artery disease (CAD) burden and type, which has been demonstrated as the strongest discriminant of future risk of major adverse cardiac events (MACE). To date, there are no clinically useful thresholds to assist with understanding a patient's disease burden and guide diagnosis and management, as there exists with coronary artery calcium (CAC) scoring. The purpose of this manuscript is to establish clinically relevant plaque stages and thresholds based on evidence from invasive angiographic stenosis (ICA) and fractional flow reserve (FFR) data. Read More

Clin Cardiol 2022 Jun 31;45(6):605-613. Epub 2022 Mar 31.

Department of Cardiology, Osaka Police Hospital, Osaka, Japan.

In patients with multivessel disease (MVD), functional information on lesions improves the prognostic capability of the SYNTAX score. Quantitative flow ratio (QFR®) is an angiography-derived fractional flow reserve (FFR) that does not require a pressure wire or pharmacological hyperemia. We aimed to investigate the feasibility of QFR-based patient information in Heart Teams' discussions to determine the optimal revascularization strategy for patients with MVD. Read More

Eur Radiol 2022 Mar 8. Epub 2022 Mar 8.

Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.

Objectives: To propose a novel functional Coronary Artery Disease-Reporting and Data System (CAD-RADS) category system integrated with coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) and to validate its effect on therapeutic decision and prognosis in patients with coronary artery disease (CAD).

Methods: Firstly, we proposed a novel functional CAD-RADS and evaluated the performance of functional CAD-RADS for guiding treatment strategies with actual clinical treatment as a reference standard in a retrospective multicenter cohort with CCTA and invasive FFR performed in all patients (n = 466). Net reclassification improvement (NRI) of functional CAD-RADS over anatomical CAD-RADS was calculated. Read More

Herz 2022 Mar 4. Epub 2022 Mar 4.

Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Deutschland.

Computed tomography coronary angiography (cCTA) is a safe option for the noninvasive exclusion of significant coronary stenoses in patients with a low or moderate pretest probability for coronary artery disease (CAD). Furthermore, it also allows functional and morphological assessment of coronary stenoses. The European Society of Cardiology (ESC) guidelines on the diagnosis and management of chronic coronary syndrome published in 2019 have strengthened the importance of cCTA in this context and for this reason it has experienced a considerable upgrade. Read More

Curr Cardiol Rep 2022 05 2;24(5):541-550. Epub 2022 Mar 2.

University of California, Irvine, USA.

Purpose Of Review: Multivessel coronary artery disease, defined as significant stenosis in two or more major coronary arteries, is associated with high morbidity and mortality. The diagnosis and treatment of multivessel disease have evolved in the PCI era from solely a visual estimation of ischemic risk to a functional evaluation during angiography. This review summarizes the evidence and discusses the commonly used methods of multivessel coronary artery stenosis physiologic assessment. Read More

JACC Cardiovasc Interv 2022 02;15(4):427-439

Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.

Objectives: The aim of this study was to evaluate the impact of thrombotic risk on the occurrence of cardiovascular events in patients with coronary artery disease with deferred revascularization after fractional flow reserve (FFR) measurements.

Background: Deferral of revascularization on the basis of FFR is generally considered to be safe, but after deferral, some patients have cardiovascular events over time.

Methods: From J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), 1,263 patients with deferral of revascularization on the basis of FFR were evaluated. Read More

Eur Radiol 2022 Feb 17. Epub 2022 Feb 17.

Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.

Objectives: To explore downstream management and outcomes of machine learning (ML)-based CT derived fractional flow reserve (FFR) strategy compared with an anatomical coronary computed tomography angiography (CCTA) alone assessment in participants with intermediate coronary artery stenosis.

Methods: In this prospective study conducted from April 2018 to March 2019, participants were assigned to either the CCTA or FFR group. The primary endpoint was the rate of invasive coronary angiography (ICA) that demonstrated non-obstructive disease at 90 days. Read More

Eur Heart J Cardiovasc Imaging 2022 03;23(4):e136-e161

Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany.

Cardiac computed tomography (CT) was initially developed as a non-invasive diagnostic tool to detect and quantify coronary stenosis. Thanks to the rapid technological development, cardiac CT has become a comprehensive imaging modality which offers anatomical and functional information to guide patient management. This is the second of two complementary documents endorsed by the European Association of Cardiovascular Imaging aiming to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. Read More

J Clin Med 2022 Jan 18;11(3). Epub 2022 Jan 18.

Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.

Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. Read More

High Blood Press Cardiovasc Prev 2022 May 11;29(3):207-219. Epub 2022 Feb 11.

Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.

Coronary artery disease (CAD) continues to be the leading cause of mortality and morbidity in developed countries. Assessment of pre-test probability (PTP) based on patient's characteristics, gender and symptoms, help to identify more accurate patient's clinical likelihood of coronary artery disease. Consequently, non-invasive imaging tests are performed more appropriately to rule in or rule out CAD rather than invasive coronary angiography (ICA). Read More

Am J Prev Cardiol 2022 Mar 20;9:100318. Epub 2022 Jan 20.

Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.

In this clinical practice statement, we represent a summary of the current evidence and clinical applications of cardiac computed tomography (CT) in evaluation of coronary artery disease (CAD), from an expert panel organized by the American Society for Preventive Cardiology (ASPC), and appraises the current use and indications of cardiac CT in clinical practice. Cardiac CT is emerging as a front line non-invasive diagnostic test for CAD, with evidence supporting the clinical utility of cardiac CT in diagnosis prevention. CCTA offers several advantages beyond other testing modalities, due to its ability to identify and characterize coronary stenosis severity and pathophysiological changes in coronary atherosclerosis and stenosis, aiding in early diagnosis, prognosis and management of CAD. Read More

Circ Cardiovasc Interv 2022 02 8;15(2):e011387. Epub 2022 Feb 8.

Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Japan (N.T.).

Background: Little large-scale data is available about the long-term (beyond 3 years) clinical outcomes after fractional flow reserve (FFR)-based deferral of revascularization in clinical practice. We sought to assess the 5-year outcomes after deferral of revascularization based on FFR.

Methods: The J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry) prospectively enrolled 1263 patients with 1447 lesions in whom revascularization was deferred based on FFR from 28 Japanese centers. Read More

Radiographics 2022 Mar-Apr;42(2):340-358. Epub 2022 Feb 4.

From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (P.R., E.W., P.M.Y.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.).

CT fractional flow reserve (FFR) is a physiologic simulation technique that models coronary flow from routine coronary CT angiography (CTA). To evaluate lesion-specific ischemia, FFR is measured 2 cm distal to a stenotic lesion. FFR greater than 0. Read More

JACC Cardiovasc Imaging 2022 04 12;15(4):607-625. Epub 2022 Jan 12.

University Hospital Lausanne, Cardiology and Cardiac MR Centre, Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland. Electronic address:

Objectives: The aim of this study was to compare the costs of a noninvasive cardiac magnetic resonance (CMR)-guided strategy versus 2 invasive strategies with and without fractional flow reserve (FFR).

Background: Coronary artery disease (CAD) is a major contributor to the public health burden. Stress perfusion CMR has excellent accuracy to detect CAD. Read More

J Cardiovasc Med (Hagerstown) 2022 02;23(2):119-126

Sant'Andrea Hospital, Division of Cardiology, Department of Emergency, Spezia, Italy.

Aims: We assessed a combined strategy of fractional flow reserve (FFR) plus angiography in stratifying cardiovascular risk in patients with type 1 myocardial infarction (T1MI) or type 2 (T2MI) non-ST elevation acute myocardial infarction (NSTEMI).

Methods: A cohort of 150 NSTEMI patients were prospectively studied. Clinical and angiographic features guided the identification of T1MI vs T2MI and the treatment of culprit lesions. Read More

JACC Cardiovasc Interv 2021 11 27;14(22):2519-2520. Epub 2021 Oct 27.

Department of Interventional Cardiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bron, France. Electronic address:

Front Cardiovasc Med 2021 22;8:735008. Epub 2021 Oct 22.

Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.

The current management of acute coronary syndromes (ACS) is with an invasive strategy to guide treatment. However, identifying the lesions which are physiologically significant can be challenging. Non-invasive imaging is generally not appropriate or timely in the acute setting, so the decision is generally based upon visual assessment of the angiogram, supplemented in a small minority by invasive pressure wire studies using fractional flow reserve (FFR) or related indices. Read More

J Cardiovasc Comput Tomogr 2022 May-Jun;16(3):198-206. Epub 2021 Oct 29.

Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address:

In the absence of disease impacting the coronary arteries or myocardium, there exists a linear relationship between vessel volume and myocardial mass to ensure balanced distribution of blood supply. This balance may be disturbed in diseases of either the coronary artery tree, the myocardium, or both. However, in contemporary evaluation the coronary artery anatomy and myocardium are assessed separately. Read More

J Am Coll Cardiol 2021 11;78(19):1875-1885

Hôpital Européen George Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.

Background: There is limited evidence that fractional flow reserve (FFR) is effective in guiding therapeutic strategy in multivessel coronary artery disease (CAD) beyond prespecified percutaneous coronary intervention or coronary graft surgery candidates.

Objectives: The FUTURE (FUnctional Testing Underlying coronary REvascularization) trial aimed to evaluate whether a treatment strategy based on FFR was superior to a traditional strategy without FFR in the treatment of multivessel CAD.

Methods: The FUTURE trial is a prospective, randomized, open-label superiority trial. Read More

Circ Cardiovasc Interv 2021 12 22;14(12):e010698. Epub 2021 Oct 22.

Department of Cardiology (A.E., L.P., Y.S.A., A. Heuberger, A.-S.S., J.S., A. Haghikia, D.S., G.M.F., U.L., B.E.S., D.M.L.), Charité - University Medicine Berlin, Campus Benjamin Franklin, Germany.

Background: Quantitative flow ratio (QFR) has been introduced as a novel angiography-based modality for fast hemodynamic assessment of coronary artery lesions and validated against fractional flow reserve. This study sought to define the prognostic role of pancoronary QFR assessment in patients with acute coronary syndrome (ACS) including postinterventional culprit and nonculprit vessels.

Methods: In a total of 792 patients with ACS (48. Read More

Catheter Cardiovasc Interv 2022 01 15;99(1):E12-E21. Epub 2021 Oct 15.

Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.

Objective: To evaluate the prognostic implications of atherosclerosis functional pattern on ischemia-causing vessels received percutaneous coronary intervention (PCI) or conservative treatment.

Background: Quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) index is recently proposed to characterize atherosclerosis functional pattern, but its prognostic value remains unclear.

Methods: QFR-derived PPG index was retrospectively calculated in patients from the PANDA III trial. Read More

Radiology 2022 01 5;302(1):50-58. Epub 2021 Oct 5.

From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., A.F.A., U.J.S., T.E., B.Y., I.K., A.V., C.W., A.M., R.R.B., A.V.S., M.K., J.W., J.R.B.), and Division of Cardiology, Department of Medicine (R.R.B., D.S., N.A.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Room 2301, Charleston, SC 29425-2503; Siemens Medical Solutions, Malvern, Pa (P.S.); Siemens Healthineers, Forchheim, Germany (C.S.); and Department of Radiology, Florida Hospital, Orlando, Fla (T.J.W.).

Background The role of CT angiography-derived fractional flow reserve (CT-FFR) in pre-transcatheter aortic valve replacement (TAVR) assessment is uncertain. Purpose To evaluate the predictive value of on-site machine learning-based CT-FFR for adverse clinical outcomes in candidates for TAVR. Materials and Methods This observational retrospective study included patients with severe aortic stenosis referred to TAVR after coronary CT angiography (CCTA) between September 2014 and December 2019. Read More

PLoS One 2021 1;16(10):e0258047. Epub 2021 Oct 1.

School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.

Quantification of pressure drop across stenotic arteries is a major element in the functional assessment of occlusive arterial disease. Accurate estimation of the pressure drop with a numerical model allows the calculation of Fractional Flow Reserve (FFR), which is a haemodynamic index employed for guiding coronary revascularisation. Its non-invasive evaluation would contribute to safer and cost-effective diseases management. Read More

Indian J Radiol Imaging 2021 Apr 28;31(2):291-296. Epub 2021 Jul 28.

Department of Computed Tomography, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India.

Computed tomographic coronary angiographic (CTCA) has evolved into a robust technique to detect significant stenosis; however, there is a discordance in the anatomic and functional significance of stenosis. Therefore, patients with stable coronary artery disease need to be further evaluated before deciding for any revascularization procedure. A total of 100 consecutive patients of suspected stable coronary artery disease who underwent CTCA were evaluated for functional significance of lesions using onsite computed tomography fractional flow reserve (CTFFR) and the results were compared for detection of both significant and hemodynamically significant/severe stenosis on per vessel and per patient basis and differences were statistically analyzed. Read More

J Cardiovasc Comput Tomogr 2022 Jan-Feb;16(1):19-26. Epub 2021 Sep 2.

Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia.

Background: The role of change in fractional flow reserve derived from CT (FFR) across coronary stenoses (ΔFFR) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown.

Objectives: To investigate the incremental value of ΔFFR in predicting early revascularization and improving efficiency of catheter laboratory utilization.

Materials: Patients with CAD on coronary CT angiography (CCTA) were enrolled in an international multicenter registry. Read More

J Ayub Med Coll Abbottabad 2021 Jul-Sep;33(3):376-381

Manchester Royal Infirmary, *Manchester University NHS Foundation Trust, United Kingdom.

Within the last few years, advances in CT coronary imaging has revolutionised the diagnostic flow of suspected coronary artery disease. CT coronary angiogram has a high diagnostic accuracy and negative predictive value for diagnosis of coronary disease. Its non-invasive nature makes it a lower risk and lower cost procedure compared to conventional invasive coronary angiogram. Read More

J Am Coll Cardiol 2021 08;78(7):713-736

Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.

Coronary computed tomography angiography (CTA) has shown great technological improvements over the last 2 decades. High accuracy of CTA in detecting significant coronary stenosis has promoted CTA as a substitute for conventional invasive coronary angiography in patients with suspected coronary artery disease. In patients with coronary stenosis, CTA-derived physiological assessment is surrogate for intracoronary pressure and velocity wires, and renders possible decision-making about revascularization solely based on computed tomography. Read More

Coron Artery Dis 2022 05;33(3):182-188

Department of Medicine, Cardiovascular Disease, NYU Langone Health, Brooklyn, NY, USA.

Introduction: Multiple risk models are used to predict the presence of obstructive coronary artery disease (CAD) in patients with chest pain. We aimed to compare the performance of these models to an experienced cardiologist's assessment utilizing coronary angiography (CA) as a reference.

Materials And Methods: We prospectively enrolled patients without known CAD referred for elective CA. Read More