title: Fractional flow reserve: lessons from PLATFORM and future perspectives.
abstract: In the treatment of stable coronary artery disease (CAD) the identification of patients who may gain the highest benefit from further invasive treatments is of pivotal importance for the healthcare system. In this setting, it has been established that an ischemia-guided revascularization strategy yields improved clinical outcomes in a cost-effective fashion compared with anatomy-guided revascularization alone. Invasive fractional flow reserve (FFR) is considered the gold standard, especially in the intermediate-range atherosclerotic lesions, for assessing lesion specific ischemia at the time of invasive coronary angiography and has now become the standard of reference for studies assessing the diagnostic performance of the various non-invasive stress tests. Coronary computed tomography angiography (cCTA) is an increasingly utilized non-invasive test that enables direct anatomical visualization of CAD in the epicardial coronary arteries with excellent sensitivity and negative predictive value. However, cCTA alone has poor specificity with FFR. With advances in computational fluid dynamics, it is possible to derive FFR from cCTA datasets improving its positive predictive value and specificity. The aim of this review is to summarize the technical aspects of FFR-CT, clinical evidence and limitations behind the novel technology, with a special focus on the recent PLATFORM Trial analyzing the effectiveness, clinical outcomes and resource utilization of FFR-CT. Finally, the future perspective of FFR-CT will be presented.
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy - gianluca.pontone@ccfm.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.affiliation: Department of Cardiology, San Giovanni Di Dio Hospital, Agrigento, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Carità
authors.affiliation: Department of Radiology, Istituto Clinico Città Studi, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Verdecchia
authors.affiliation: Department of Cardiology, San Giacomo D'Altopasso Hospital, Licata (AG), Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Buccheri
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.|Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.affiliation: Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital &quot;Policlinico Consorziale&quot; of Bari, Bari, Italy.|Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Andrea I
authors.initials: AI
authors.lastname: Guaricci
authors.affiliation: Department of Medicine, Division of Cardiology, Loyola University Chicago, Chicago, IL, USA.|Department of Medicine, Division of Cardiology, Edward Hines Jr. VA Hospital, Hines, IL, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Rabbat
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods