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Objectives <p>Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (CT-FFR) has emerged as a critical tool for assessing functional ischemia in coronary artery disease (CAD). This expert consensus, developed by an international working group, provides a comprehensive overview of the clinical applications, diagnostic performance, and future perspectives of CT-FFR.</p> Methods and results <p>The consensus highlights the use of CT-FFR as an indicator for abnormal coronary physiology, demonstrating superior diagnostic performance over anatomical CCTA alone, with pooled accuracy of 71%–91%, sensitivity of 76%–98% and specificity of 61%–94% at the per-vessel level, particularly in intermediate lesions. It also addresses factors influencing CT-FFR’s diagnostic performance, including technical, physiological, and measurement-related considerations. The document discusses the role of CT-FFR in decision-making, serving as a gatekeeper for invasive coronary angiography (ICA) and aiding in percutaneous coronary intervention (PCI) planning. Additionally, CT-FFR shows promise as a prognostic marker, with lower CT-FFR values associated with a higher risk of major adverse cardiovascular events (MACE). Economic evaluations indicate that CT-FFR is cost-effective compared to traditional non-invasive strategies. The consensus also explores the application of CT-FFR in complex lesions and non-atherosclerotic diseases, such as myocardial bridging and anomalous aortic origin of coronary arteries. Future directions include the development of more accurate CT-FFR approaches and the exploration of CT-FFR-based risk stratification.</p> Conclusions <p>This consensus aims to provide guidance for radiologists, cardiologists, and other healthcare professionals, promoting the standardized and evidence-based use of CT-FFR in clinical practice.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis><i> Inconsistent implementation and evidence gap of CT-derived fractional flow reserve need an international consensus to optimize functional assessment of coronary artery disease and downstream management</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis><i> This consensus standardizes CT-derived fractional flow reserve application, validating its diagnostic performance (accuracy 71%–91%, sensitivity 76%–98%, specificity 61%–94%), utility in guiding revascularization, and prognostic value</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis><i> Standardized CT-derived fractional flow reserve use can optimize patient management by effectively reducing unnecessary invasive coronary angiography, guiding targeted revascularization, and improving risk prediction based on lesion-specific physiology</i>.</p> Graphical Abstract <p></p>

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Clinical use of coronary computed tomography angiography-derived fractional flow reserve: expert consensus by an International Working Group

  • 期刊论文

  • 发表日期：

    2026年2月13日

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  • Chun Xiang Tang,
  • Jonathon A. Leipsic,
  • Bjarne L. Nørgaard,
  • Pontone Gianluca,
  • Christian Tesche,
  • Junjie Yang,
  • Bon-Kwon Koo,
  • Carlos Collet,
  • Mouaz H. Al-Mallah,
  • Lei Xu,
  • Jia Yin Zhang,
  • Neng Dai,
  • Guang Ming Lu,
  • Min Wen Zheng,
  • Long Jiang Zhang,
  • U. Joseph Schoepf

摘要

Objectives

Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (CT-FFR) has emerged as a critical tool for assessing functional ischemia in coronary artery disease (CAD). This expert consensus, developed by an international working group, provides a comprehensive overview of the clinical applications, diagnostic performance, and future perspectives of CT-FFR.

Methods and results

The consensus highlights the use of CT-FFR as an indicator for abnormal coronary physiology, demonstrating superior diagnostic performance over anatomical CCTA alone, with pooled accuracy of 71%–91%, sensitivity of 76%–98% and specificity of 61%–94% at the per-vessel level, particularly in intermediate lesions. It also addresses factors influencing CT-FFR’s diagnostic performance, including technical, physiological, and measurement-related considerations. The document discusses the role of CT-FFR in decision-making, serving as a gatekeeper for invasive coronary angiography (ICA) and aiding in percutaneous coronary intervention (PCI) planning. Additionally, CT-FFR shows promise as a prognostic marker, with lower CT-FFR values associated with a higher risk of major adverse cardiovascular events (MACE). Economic evaluations indicate that CT-FFR is cost-effective compared to traditional non-invasive strategies. The consensus also explores the application of CT-FFR in complex lesions and non-atherosclerotic diseases, such as myocardial bridging and anomalous aortic origin of coronary arteries. Future directions include the development of more accurate CT-FFR approaches and the exploration of CT-FFR-based risk stratification.

Conclusions

This consensus aims to provide guidance for radiologists, cardiologists, and other healthcare professionals, promoting the standardized and evidence-based use of CT-FFR in clinical practice.

Key Points

Question Inconsistent implementation and evidence gap of CT-derived fractional flow reserve need an international consensus to optimize functional assessment of coronary artery disease and downstream management.

Findings This consensus standardizes CT-derived fractional flow reserve application, validating its diagnostic performance (accuracy 71%–91%, sensitivity 76%–98%, specificity 61%–94%), utility in guiding revascularization, and prognostic value.

Clinical relevance Standardized CT-derived fractional flow reserve use can optimize patient management by effectively reducing unnecessary invasive coronary angiography, guiding targeted revascularization, and improving risk prediction based on lesion-specific physiology.

Graphical Abstract