Integrated cardiac assessment combining anatomical and functional data.

Beyond the Scan: Are We Ready for One-Stop Heart Health Assessments?

Elliot Brynn in Health & Wellness August 2025 • 4 min read.

"Combining Coronary Anatomy and Hemodynamics for Comprehensive Cardiac Care"

For individuals dealing with coronary artery disease, determining the presence of ischemia is crucial because it significantly influences prognosis and helps identify those most likely to benefit from revascularization. It's important to recognize that the severity of a coronary stenosis alone doesn't dictate downstream myocardial perfusion. Recent trials using invasive fractional flow reserve (FFR) have demonstrated that basing revascularization decisions on whether a coronary stenosis is hemodynamically significant, rather than just its anatomical severity, improves patient outcomes.

These studies also indicate that non-hemodynamically significant coronary stenoses can be safely managed with medical therapy alone. Conversely, relying solely on medical management for hemodynamically significant stenoses may lead to poorer outcomes. While FFR is a valuable tool for assessing the hemodynamic significance of coronary stenosis, it remains an invasive procedure. Thus, there's a continuing need for a noninvasive method to determine both the presence of a coronary stenosis and its hemodynamic significance.

Ideally, such a strategy would provide comprehensive anatomic and functional data about coronary artery disease accurately, cost-effectively, and conveniently, ultimately enhancing patient outcomes and guiding treatment plans.

The Promise of CCTA: Visualizing Anatomy and Function

Integrated cardiac assessment combining anatomical and functional data.

Coronary computed tomography angiography (CCTA) emerges as a precise, noninvasive imaging technique, delivering a comprehensive anatomical evaluation of coronary arteries comparable to invasive coronary angiography. Its high negative predictive value makes CCTA useful for identifying patients with nonobstructive disease who could benefit from medical therapy. However, CCTA alone doesn't provide information on the functional significance of a visualized lesion. Assessing the severity of stenosis can also be challenging in the presence of coronary calcification, stents, and bypass grafts.

The PROMISE trial highlighted that using CCTA alone as an initial test for evaluating chest pain resulted in similar clinical outcomes over two years compared to functional-only tests like treadmill stress testing. However, a meta-analysis of randomized trials suggests CCTA may reduce myocardial infarction rates. Currently, there are no randomized, controlled trials comparing CCTA alone to cardiac magnetic resonance or positron emission tomography stress testing.

CT-FFR (Computed Tomography Fractional Flow Reserve): This technique applies computational fluid dynamics to derive FFR values from standard CCTA images, eliminating the need for pharmacologic stress agents, additional image acquisitions, or more contrast.
CTP (Computed Tomography Perfusion): As an alternative, vasodilator CTP can be performed in patients with potentially significant coronary artery stenosis detected during CCTA. This helps determine which stenoses are hemodynamically significant and potential targets for revascularization.

The utility of CCTA lies in its potential to evaluate both coronary anatomy and hemodynamic status in a single exam using techniques like computed tomography fractional flow reserve (CT-FFR) or computed tomography perfusion (CTP). CT-FFR uses computational fluid dynamics to derive FFR values.

The Horizon of Cardiac Diagnostics

The integration of CCTA with CTP holds great promise for enhancing cardiac diagnostics, potentially reducing the need for invasive procedures and improving patient outcomes. As research continues and technology advances, the ability to comprehensively assess coronary anatomy and function noninvasively moves closer to becoming a clinical reality, offering a more streamlined, patient-friendly approach to managing heart disease.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.jcmg.2017.12.021, Alternate LINK

Title: Noninvasive Assessment Of Coronary Anatomy And Its Hemodynamic Consequences During A Single Test

Subject: Cardiology and Cardiovascular Medicine

Journal: JACC: Cardiovascular Imaging

Publisher: Elsevier BV

Authors: Amit R. Patel, Neha Goyal

Published: 2018-11-01

Everything You Need To Know

What is Coronary computed tomography angiography (CCTA), and why is it used?

Coronary computed tomography angiography (CCTA) is a noninvasive imaging technique that provides a detailed anatomical evaluation of the coronary arteries. It's significant because it can identify patients with nonobstructive coronary artery disease who might benefit from medical therapy. However, CCTA alone doesn't provide information about the functional significance of any visualized lesions. The implications of using CCTA include a comprehensive anatomical assessment but require additional functional testing to determine the hemodynamic impact of any identified stenosis.

What is Computed Tomography Fractional Flow Reserve (CT-FFR), and why is it valuable?

Computed Tomography Fractional Flow Reserve (CT-FFR) is a technique that uses computational fluid dynamics applied to standard CCTA images to derive fractional flow reserve (FFR) values. This is important because it eliminates the need for pharmacologic stress agents, additional image acquisitions, or more contrast, offering a less invasive way to assess the hemodynamic significance of coronary stenosis. The implications of CT-FFR involve providing functional data alongside anatomical data from a single CCTA scan, potentially improving diagnostic accuracy and reducing the need for invasive procedures.

What is Computed Tomography Perfusion (CTP), and how does it help in assessing heart conditions?

Computed Tomography Perfusion (CTP) is a technique that involves performing a vasodilator CTP in patients with potentially significant coronary artery stenosis detected during CCTA. CTP helps determine which stenoses are hemodynamically significant and are potential targets for revascularization. This is significant because it adds a functional assessment to the anatomical data provided by CCTA. The implications of CTP include guiding treatment decisions by identifying stenoses that cause ischemia, potentially improving patient outcomes by targeting the most critical lesions.

Why is the combination of Coronary computed tomography angiography (CCTA) and Computed Tomography Perfusion (CTP) considered promising?

The integration of Coronary computed tomography angiography (CCTA) with Computed Tomography Perfusion (CTP) is significant because it allows for a comprehensive assessment of both coronary anatomy and hemodynamic status in a single exam. This approach is important for accurately diagnosing and managing coronary artery disease, as it combines the anatomical detail of CCTA with the functional information provided by CTP. The implications of this integration include reducing the need for invasive procedures, improving patient outcomes, and providing a more streamlined and patient-friendly approach to cardiac diagnostics.

What is fractional flow reserve (FFR), and why is it important in determining treatment for coronary stenosis?

Fractional flow reserve (FFR) is an invasive procedure used to assess the hemodynamic significance of a coronary stenosis. It is important because basing revascularization decisions on whether a coronary stenosis is hemodynamically significant, rather than just its anatomical severity, improves patient outcomes. The implication of using FFR is that it helps identify which stenoses are actually causing ischemia and warrant intervention, while non-hemodynamically significant stenoses can be safely managed with medical therapy.