title: The New Frontier of Cardiac Computed Tomography Angiography: Fractional Flow Reserve and Stress Myocardial Perfusion.
abstract: The increased number of patients with coronary artery disease (CAD) in developed countries is of great clinical relevance and involves a large burden of the healthcare system. The management of these patients is focused on relieving symptoms and improving clinical outcomes. Therefore the ideal test would provide the correct diagnosis and actionable information. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography (ICA), but their diagnostic yield remains low with limited accuracy when compared to obstructive CAD at the time of ICA or invasive fractional flow reserve (FFR). Invasive FFR is considered the gold standard for the evaluation of functionally relevant CAD. Therefore, an urgent need for non-invasive techniques that evaluate both the functional and morphological severity of CAD is growing. Coronary computed tomography angiography (CCTA) has emerged as a unique non-invasive technique providing coronary artery anatomic imaging. More recently, the evaluation of FFR with CCTA (FFRCT) has demonstrated high diagnostic performance compared to invasive FFR. Additionally, stress myocardial computed tomography perfusion (CTP) represents a novel tool for the diagnosis of ischemia with high diagnostic accuracy. Compared to nuclear imaging and cardiac magnetic resonance imaging, both FFRCTand stress-CTP, allow us to integrate the anatomical evaluation of coronary arteries with the functional relevance of coronary artery lesions having the potential to revolutionize the diagnostic paradigm of suspected CAD. FFRCTand stress-CTP could be assimilated in diagnostic pathways of patients with stable CAD and will likely result in a decrease of invasive diagnostic procedures and costs. The current review evaluates the technical aspects and clinical experience of FFRCTand stress-CTP in the evaluation of functionally relevant CAD discussing the strengths and weaknesses of each approach.
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy. gianluca.pontone@ccfm.it.
authors: Gianluca
authors: G
authors: Pontone
authors: Department of Imaging, Bambino Gesù-Children's Hospital IRCCS, Rome, Italy.
authors: Giuseppe
authors: G
authors: Muscogiuri
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.|Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy.
authors: Daniele
authors: D
authors: Andreini
authors: Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital "Policlinico Consorziale" of Bari, Bari, Italy.|Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors: Andrea I
authors: AI
authors: Guaricci
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
authors: Marco
authors: M
authors: Guglielmo
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
authors: Saima
authors: S
authors: Mushtaq
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
authors: Andrea
authors: A
authors: Baggiano
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
authors: Edoardo
authors: E
authors: Conte
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
authors: Virginia
authors: V
authors: Beltrama
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
authors: Andrea
authors: A
authors: Annoni
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
authors: Alberto
authors: A
authors: Formenti
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
authors: Elisabetta
authors: E
authors: Mancini
authors: Loyola University of Chicago, Chicago, IL, USA.|Edward Hines Jr. VA Hospital, Hines, IL, USA.
authors: Mark G
authors: MG
authors: Rabbat
authors: Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
authors: Mauro
authors: M
authors: Pepi
keywords: Coronary artery disease; Diagnosis; Fractional flow reserve; Ischemia; Myocardial perfusion