Fractional Flow Reserve Derived from Coronary CTA

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 1.50
Procedures: 1.50
Hemodynamics, Calculations, and Percutaneous Intervention: 1.50

Computed Tomography: 1.00
Procedures: 1.00
Neck and Chest: 1.00

Nuclear Medicine Technology: 1.00
Procedures: 1.00
Cardiac Procedures: 1.00

Registered Radiologist Assistant: 3.00
Procedures: 3.00
Thoracic Section: 3.00

Outline

1. Introduction
2. Invasive FFR Determination
3. Noninvasive Modalities for the Functional Evaluation of CAD
4. Noninvasive FFRCT
5. Current Evidence
   1. Diagnostic Accuracy and Validation
   2. Intermediate Stenosis
   3. Calcification
6. Clinical Implications
   1. Impact on Patient Care
   2. Treatment Planning Based on Virtual Stent Placement
   3. Cost-effectiveness and Quality of Life
   4. Contextualization and Comparison of FFRCT with Other Noninvasive Functional Tests
7. Limitations
8. Future Outlook and Conclusion

Objectives

Upon completion of this course, students will:

1. identify the reference standard technique for diagnosis of CAD
2. understand the outcomes related to FFR values
3. be familiar with how invasive FFR measurements are determined
4. identify the methods of administrating vasodilators during FFR
5. be familiar with the use of FFR-informed treatment decision making
6. be familiar with the reasons FFR may be underutilized
7. be familiar with MPI SPECT imaging
8. identify the limitations of MPI SPECT imaging
9. identify the limitations of MR cardiac imaging
10. be familiar with the evolution of CT angiography
11. be familiar with current CT imaging techniques for myocardial perfusion
12. be familiar with TAG
13. be familiar with correction models when using TAG
14. be familiar with the diagnostic accuracy of TAG
15. be familiar with the computation of fractional myocardial mass
16. identify the study on the diagnostic performance of fractional myocardial mass
17. be familiar with postprocessing techniques used in FFRCT
18. identify the factors that make FFRCT possible
19. identify the equations used to calculate FFRCT values
20. identify the models to overcome the limitations of 3D models when calculating FFRCT
21. be familiar with the deep learning algorithm
22. be familiar with the DISCOVER-FLOW trial
23. be familiar with the findings in the DISCOVER-FLOW trial
24. be familiar with the DeFACTO trial
25. understand the outcomes of the DeFACTO trial
26. be familiar with the details surrounding the NXT trial
27. be familiar with the improvement in accuracy when using FFRCT
28. be familiar with the meta-analysis study conducted on FFRCT
29. identify the outcomes of the NXT trial to reclassify patients correctly
30. be familiar with the impact of workstation-based FFRCT on intermediate stenosis
31. be familiar with the impact of coronary calcification on FFRCT calculations
32. be familiar with impact FFRCT can have on patient care
33. understand the impact FFRCT can have on reducing unnecessary ICA procedures
34. be familiar with the outcomes of the RIPCORD trial
35. understand the impact FFRCT can have on treatment strategy
36. be familiar with the utility and impact of FFRCT on decision making and down stream testing
37. identify the study conducted that demonstrated the utility of FFRCT to predict the functional outcome of percutaneous coronary intervention
38. be familiar with research that is focusing on comparing FFRCT with other noninvasive diagnostic tests
39. be familiar with the limitations of FFRCT
40. be familiar with the advantages of FFRCT as a single noninvasive test