Functional assessment of coronary artery disease by cardiac computed tomography

ABSTRACT

Introduction: Rapid technological advances in computed tomography (CT) have allowed CT coronary angiography (CTCA) to be delivered at low radiation dose and high diagnostic accuracy. Due to its high negative predictive value for coronary artery disease, it has become a gatekeeper for the assessment of patients with chest pain of recent onset. Second line functional assessment of a detected coronary stenosis relies mostly on other imaging modalities. Functional assessment of coronary artery disease by CT is therefore an attractive addition to CTCA.

Areas covered: This review will discuss the current evidence base and future development for CT perfusion imaging. Furthermore, this review will discuss CT-derived fractional flow reserve and CT coronary plaque characteristics as alternative approaches for functional evaluation of coronary artery disease. Finally, combining coronary anatomy and functional assessment of coronary flow with myocardial tissue characterization by CT may be attractive allowing triple assessment by CT.

Expert commentary: The combined use of CTCA and functional assessment of coronary artery stenosis by CT perfusion or CT-derived fractional flow reserve is an attractive diagnostic pathway that requires further evaluation.

KEYWORDS:

• Cardiac computed tomography
• myocardial perfusion imaging
• CT FFR

Acknowledgment

The colour FFR_CT figure in Figure 3 was provided by HeartFlow Inc, Redwood City, California, United States.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This work forms part of the translation research portfolio of the NIHR Cardiovascular Biomedical Research Unit at Barts, which is supported and funded by the NIHR.