April 20, 2026Journal of the American College of Cardiology
Diagnostic Performance of Noninvasive Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography in Suspected Coronary Artery Disease
Key result
FFR-CT outperforms standard CTA in diagnostic accuracy for identifying myocardial ischemia.
- AUC
- 95% CI 0.87 to 0.94
- P=0.0008
- n=254
Why the study?
FFR during ICA is the gold standard for revascularization decisions in stable CAD, but the potential for FFR(CT) to noninvasively identify ischemia had not been sufficiently investigated.
Does FFR(CT) improve diagnostic accuracy for myocardial ischemia compared to coronary CTA in patients with suspected stable CAD?
Population
254 patients scheduled for clinically indicated ICA for suspected CAD
Comparison
FFR(CT) vs coronary CTA vs ICA, compared with invasively measured FFR
Design
Prospective multicenter trial with blinded core laboratory interpretation
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
BNBjarne NørgaardCardiologist, Aarhus University Hospital, Denmark
“Fractional flow reserve non-invasively calculated from coronary CTA data sets matches closely with invasively measured FFR and allows for identification of patients with hemodynamically significant coronary lesions with good accuracy. When compared to both coronary CTA and ICA, FFR-CT led to a significant reduction in the proportion of false-positive results. The addition of FFR-CT to coronary CTA allows for a comprehensive anatomic and functional assessment of coronary artery disease.”
HSHarvey S. HechtCardiologist, Icahn School of Medicine at Mount Sinai
“FFR-CT is the first noninvasive test to be validated from its inception by an outcome-based gold standard (ie, invasive FFR) rather than one ultimately based on coronary stenosis measurement.”
BNBjarne NørgaardCardiologist, Aarhus University Hospital, Denmark
“An abundance of data has demonstrated that FFRCT has high diagnostic accuracy when compared to FFR, and in several reports FFRCT showed promise as a valuable test in clinical practice. For example, several studies indicate that FFRCT may offset the higher downstream utilization of invasive catheterization by CTA and favorably influence clinical outcomes.”
Implication
FFR(CT) may improve triage to invasive angiography in suspected CAD; leaves open effects on clinical outcomes pending randomized trials.
Key Points
- This research aimed to evaluate the diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in identifying myocardial ischemia in patients with suspected coronary artery disease.
- Prospective multicenter trial involving 254 patients undergoing invasive coronary angiography for suspected CAD.
- Coronary computed tomography angiography was performed prior to invasive coronary angiography.
- Blinded calculations of fractional flow reserve derived from CT compared with invasively measured fractional flow reserve.
- FFR(CT) achieved an area under the receiver-operating characteristic curve of 0.90, surpassing 0.81 for coronary CTA (p=0.0008).
- Sensitivity and specificity for FFR(CT) were 86% and 79% compared to 94% and 34% for CTA, respectively.
- In patients with intermediate stenosis, FFR(CT) maintained high diagnostic accuracy.
Study Design
Type
Observational (n=254)
Blinding
Blinded
Multicenter
Yes
Structured PICO
Does FFR(CT) improve diagnostic accuracy for myocardial ischemia compared to coronary CTA in patients with suspected stable CAD?
P
Population
254 patients scheduled to undergo clinically indicated invasive coronary angiography (ICA) for suspected stable coronary artery disease (CAD).
I
Intervention
Noninvasive fractional flow reserve derived from coronary computed tomography angiography (FFR(CT))
C
Comparator
Coronary CTA (anatomic testing) and invasive coronary angiography (ICA), with invasively measured FFR as the reference standard
O
Outcome
Diagnostic performance (area under the receiver-operating characteristic curve, sensitivity, specificity) for identifying myocardial ischemia (defined as FFR(CT) or FFR ≤0.80)surrogate
Main Result
Effect estimate: AUC (95% CI 0.87 to 0.94)
Absolute Event Rate: 0.9% vs 0.81%
p-value: p=0.0008
FFR(CT) provides high diagnostic accuracy and significantly improves specificity for detecting hemodynamically significant CAD compared to standard coronary CTA.
Cite This Study
Nørgaard et al. (2014) conducted an observational in Suspected stable coronary artery disease (CAD) (n=254). Noninvasive fractional flow reserve derived from coronary CTA (FFR(CT)) vs. Coronary CTA was evaluated on Area under the receiver-operating characteristic curve for identifying myocardial ischemia (AUC, 95% CI 0.87 to 0.94, p=0.0008). Noninvasive FFR derived from coronary CTA demonstrated higher diagnostic accuracy for identifying myocardial ischemia compared to standard coronary CTA (AUC 0.90 vs 0.81; p=0.0008).