CAC Meeting Agenda, Key Questions for Discussion, and Bibliography: FFRct

The purpose of the meeting is to obtain advice from Contractor Advisory Committee (CAC) members and subject matter experts (SMEs) regarding the strength of published evidence on Fractional Flow Reserve Computed Tomography (FFRct).

View the related CAC information on this page.

Agenda

3-5 p.m. CT

  1. Welcome and Introduction
    • Facilitator: Dr. Laurence Clark, MD, FACP
  2. Key Questions and Discussion
    • CAC Members, Invited Subject Matter Experts, Contractor Medical Directors
  3. Closing Remarks and Adjournment

Key Questions for Discussion

  1. Is FFRct a reliable reflection of fractional flow reserve as determined by catheterization and pressure wire assessment?
  2. Is there a standard definition of Intermediate Coronary Stenosis? (40-70% of luminal narrowing by visual assessment of an epicardial stenosis measured in the "worst view" angiographic projection?)
  3. What are the relative values of non-invasive stress imaging and FFRct in the assessment of stable ischemic heart disease?
  4. It has been reported that FFRct is of limited value in patients with BMI greater than or equal to 35. Are there other physical limitations or patient characteristics to be avoided with this technology?
  5. Does the general consensus regarding CCTA findings of high-risk lesions, low risk lesions, and more than 2 intermediate risk lesions preclude FFRct analysis?
  6. Is there a standard clinical definition of low-to-intermediate risk patients for CAD?
  7. Should risk factor assessment factor into the ordering of FFRct, or should its use be based on anatomic criteria?
  8. What is the clinical utility of performing this test on an asymptomatic patient with risk factors?

Bibliography

Suggested Reading for FFRct Panelists (please feel free to suggest additional articles or more recent substitutions)

  1. Clinical Outcomes Using CCTA and FFRCT - Guided Management of Patients with Stable Chest Pain, ACC Expert Analysis, Apr. 17, 2019, Lavinia Gabora: Nick Curzen
  2. Nargaard BL, Terkelsen CJ. Clinical Outcomes Using CTA-FFRCT - Guided Management of Stable Chest Pain, JACC. 2018; Aug 25:250-252.
  3. Fihn SD, Gordon JM. Guidelines for the diagnosis and management of patients with stable ischemic heart disease, The Report of the ACC Foundation, American Heart Assoc. and American College of Physicians Circulation 2012; 126: e 354-471.
  4. Andersen JL, Adams CD. Guidelines for the Management of Patients with Unstable Angina/NSTEMI ACCT/AHA Task Force Circulation 2011; 123: e 426-579.
  5. Koo BK, Englis A. Diagnosis of ischemia causing coronary stenosis by non-invasive FFRCT, DISCOVER-FLOW JACC. 2011; 58:1989-97.
  6. Coenen A, Rossi A. Integrating CT Myocardial Perfusion and CT-FFR in the Work-Up of Coronary Artery Disease, JACC Cardiovascular Imaging supplement 2017, Jan. 12.
  7. CT Perfusion and FFRCT are Ready for Clinical Use, ACC Expert Analysis, Maroules, C, Cury, R 2017, Feb. 06.
  8. Douglas PS, Pontone G. Clinical outcomes of FFRCT vs. usual care in patients with suspected CAD, Eur Heart J. 2015;36:3359-67.
  9. Douglas PS, DeByrne B. 1-Year Outcomes of FFRCT Guided Care in Patients with suspected CAD. The PLATFORM Study, JACC. 2016; 68:435-45.
  10. HeartFlow FFRCT for estimating FFR from coronary CT angiography (NICE website) Feb. 2017 https://www.nice.org.uk/guidance/mtg32.
  11. Asher A, Singhai. A FFRCT derived from CTA, the experience in the UK, Expert Review Cardiovasc Ther. 2018; 16:919-29.

 

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