Name of the Procedure:

Noninvasive Estimated Coronary Fractional Flow Reserve (FFR)

• Common Name(s): Noninvasive FFR, Computed Tomography (CT) FFR
• Technical or Medical Terms: FFR derived from Coronary Computed Tomography Angiography (CCTA) using Computational Fluid Dynamics (CFD) Software

Summary

Noninvasive FFR is a procedure that estimates the blood flow in the coronary arteries using data from a CT angiography scan. This noninvasive test uses advanced software to simulate how blood flows through the coronary arteries, helping doctors determine if there are any significant blockages.

Purpose

Noninvasive FFR is primarily used to assess the severity of blockages or narrowings in the coronary arteries. The main goal is to determine whether these blockages are impeding the blood flow to the heart muscle, which can guide treatment decisions.

Indications

• Symptoms of coronary artery disease (CAD) such as chest pain (angina), shortness of breath, and fatigue.
• Abnormal results from other cardiac tests, such as stress tests or basic coronary CT angiography.
• Known or suspected CAD and the need to evaluate the functional significance of coronary lesions.

Preparation

• Patients may be instructed to fast for a few hours before the procedure.
• Inform your doctor of any medications you are currently taking; certain medications may need to be adjusted.
• You may be advised to avoid caffeine and nicotine before the test as they can affect heart rate.

Procedure Description

1. The patient lies on a CT scan table.
2. A contrast dye is injected into the bloodstream to make the coronary arteries visible on the CT scan images.
3. The CT scanner takes multiple cross-sectional images of the heart and coronary arteries.
4. These images are processed using computational fluid dynamics (CFD) physiologic simulation software to estimate the fractional flow reserve (FFR).
5. The software analyzes the data to assess blood flow through the coronary arteries and detect any significant blockages.

Duration

The entire procedure, including preparation, typically takes about 30 to 60 minutes.

Setting

Noninvasive FFR is usually performed in a hospital radiology department or a specialized outpatient clinic equipped with a CT scanner.

Personnel

• Cardiologist
• Radiologist
• Radiologic Technologist
• Software Specialist (for CFD analysis)

Risks and Complications

• Exposure to radiation during the CT scan.
• Allergic reaction to the contrast dye.
• Very low risk of kidney function impairment due to the contrast dye.
• Rare potential for inaccurate FFR readings due to software limitations.

Benefits

• Accurate assessment of coronary artery blockages without the need for invasive procedures.
• Can help guide treatment strategies, such as the need for angioplasty or bypass surgery.
• Noninvasive with minimal discomfort.

Recovery

• No significant recovery time is needed.
• Patients can usually resume normal activities immediately after the procedure.
• Follow-up appointments may be scheduled to discuss the results and treatment plan.

Alternatives

• Invasive Coronary Angiography: Provides direct visualization of coronary arteries but involves catheterization.
• Stress Testing: Evaluates heart function under stress but may not provide detailed anatomical information.
• MRI: Alternative imaging method, though not specifically for FFR estimation.

Patient Experience

• Patients may experience a brief sensation of warmth when the contrast dye is injected.
• The CT scan itself is painless and noninvasive.
• Some may feel anxious about the procedure, but sedation is rarely necessary.
• After the procedure, normal activities can typically be resumed without discomfort.