March 13, 2026Open Access

Diagnostic performance of on-site, CT-derived fractional flow reserve in predicting invasive fractional flow reserve and absolute myocardial blood flow

Key Result

The on-site CT-derived fractional flow reserve shows high rule-out capability for significant disease in patients with suspected stenosis at CCTA.

Key Points

The research aims to evaluate the diagnostic accuracy of on-site CT-derived fractional flow reserve in predicting invasive measures and myocardial blood flow.
Utilized a novel CT-FFR algorithm for assessments
Examined patients with suspected stenosis at CCTA
Compared CT-derived FFR to invasive FFR and myocardial blood flow.
Analyzed correlation between CT-FFR and flow measures via PET.
The CT-derived algorithm showed high rule-out capability for significant disease.
Incremental rule-in potential was noted beyond traditional measures of diameter stenosis.
Fractal flow reserve and myocardial blood flow had weak correlations with both FFR measures.

Structured PICO

Does on-site CT-derived fractional flow reserve accurately predict invasive fractional flow reserve and absolute myocardial blood flow in patients with suspected chronic coronary syndrome?

Population

38 patients (89 vessels) with suspected chronic coronary syndrome and ≥50% diameter stenosis on CCTA, mean age 64, 76% male. Scanned on GE Revolution Apex CT.

Intervention

On-site computed tomography-derived fractional flow reserve (CT-FFR) using prototype research software (XFFR version 1.4, GE Research)

Comparator

Invasive fractional flow reserve (FFR) and absolute myocardial blood flow (MBF) by [15O]H2O PET

Outcome

Agreement of CT-FFR and invasive FFRsurrogate

A novel on-site CT-FFR algorithm demonstrated high sensitivity and negative predictive value for ruling out functionally significant coronary artery disease compared to invasive FFR, though specificity was moderate.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

A novel on-site CT-FFR algorithm demonstrates fast and very high rule-out capability and incremental rule-in potential beyond diameter stenosis for functionally significant disease determined by invasive FFR in patients with suspected stenosis at CCTA. Both measures of FFR correlated weakly with myocardial blood flow and flow reserve by 15OH2O PET.

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