Computed Tomography-Derived Fractional Flow Reserve (CT-FFR): Clinical Review For Cardiologist

Introduction: Coronary artery disease (CAD) remains a major health burden worldwide. While coronary CT angiography (CCTA) offers detailed anatomy, it lacks physiological assessment. Computed tomography-derived fractional flow reserve (CT-FFR) integrates computational modeling with CCTA, enabling combined anatomical and functional evaluation of CAD. Objective: This review aims to summarize recent advances in CT-FFR regarding its diagnostic accuracy, prognostic value, and clinical applications in coronary artery disease. Methods: A literature search was conducted using the keywords (“fractional flow reserve computed tomography” OR “computed tomography-derived FFR” OR “CT-FFR” OR “FFRct” OR “CT based FFR”) in PubMed and Scopus for English-language research articles published between 2022 and 2025. Inclusion criteria were based on the PICO framework (P: Adult patients with suspected or established CAD; I: CT-FFR; C: Invasive FFR or standard CCTA; O: Diagnostic accuracy, clinical decision-making, and prognostic value). Articles were excluded due to limited access or duplication. Results: Of 911 retrieved articles, 402 were duplicates, two were non-English, 136 were non-original research studies, 342 did not meet PICO criteria, and six had limited access. Among the 23 analyzed studies, CT-FFR enhances the specificity and diagnostic accuracy of CCTA, reduces unnecessary invasive angiography, and improves revascularization decisions. It also provides prognostic value for MACE and performs well across various clinical settings, including TAVR and acute syndromes. Conclusion: CT-FFR is a reliable, noninvasive tool that integrates anatomical and functional assessment, improving diagnostic precision and supporting wider clinical adoption.