What is My Take on This Study and FFR-CT? <\/p>\n
I firmly believe FFR-CT is going to become an integral part of coronary computed tomography angiography (CCTA) evaluation when needed.<\/p>\n
This is a strong study supporting FFR-CT as a marker of prognosis, particularly when values become markedly abnormal.
However, association should not be confused with mechanism.
Lower FFR-CT inevitably reflects, at least partly, the underlying atherosclerotic burden, stenosis severity and diffuse coronary disease.<\/p>\n
We should also consider the most important limitation of the study: Plaque burden was not available.<\/p>\n
Does FFR-CT Offer Prognostic Value Beyond Quantitative Total Plaque Burden?<\/p>\n
The study authors acknowledge that it remains unknown whether FFR-CT provides incremental prognostic value over quantitative total plaque burden.<\/p>\n
This distinction matters.<\/p>\n
FFR-CT describes the physiological consequence of coronary disease. Plaque imaging measures the disease itself.With quantitative CCTA, AI-based plaque analysis and increasingly photon-counting CT (PCCT), the next comparison should therefore not simply be: \u201cstenosis + FFR-CT\u201d but rather \u201cplaque burden + plaque phenotype + stenosis + physiology.\u201d<\/p>\n
Only then will we understand how much independent prognostic information physiology really adds.<\/p>\n
Dr. Cademartiri is the director of advanced cardiovascular imaging and photon-counting CT at the Scientific Institute for Research, Hospitalization, and Healthcare Synlab Diagnostic Network in Naples, Italy. He is also a consultant in advanced cardiovascular imaging at CDI\/Centro Diagnostico Italiano in Milan, Italy.<\/p>\n