Coronary CT Angiography-Derived Fractional Flow Reserve in Asia and the United States - 2025 Status Update

Sep 30, 2026

Uploaded by Fans

Coronary CT-derived fractional flow reserve (CT-FFR) provides a noninvasive alternative to invasive FFR for evaluating the hemodynamic impact of coronary artery stenosis. It combines routinely acquired coronary CT angiography with artificial intelligence segmentation and computational fluid dynamics to estimate pressure gradients, supporting clinical decisionmaking without procedural risk. Adoption differs substantially by region: HeartMedi+ dominates in South Korea, FFRCT is emphasized in Japan, and many other areas remain in early or exploratory stages due to cost, reimbursement, and infrastructure. In the United States, guideline endorsement and reimbursement drive broader use, with HeartFlow widely applied.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Hong Kong

Focus | Cardiovascular Imaging eISSN 2005-8330 [https://doi.org/10.3348/kjr.2025.1208](https://doi.org/10.3348/kjr.2025.1208)[ ](https://doi.org/10.3348/kjr.2025.1208)[Korean J Radiol 2026](Korean J Radiol 2026);[27](27)([1](1))[:27-33](:27-33) Coronary CT Angiography-Derived Fractional Flow Reserve in Asia and the United States: 2025 Status Update Woo Jin Ahn1, Maros Ferencik2, Ming-Yen Ng3, Liang Zhong4, Mona Bhatia5, Akira Kurata6, Pannipa Suwannasom7, Yung-Liang Wan8, Trang Ngoc Nguyen9, Suyon Chang10, Sung Mok Kim11, Hwan Seok Yong12, Cherry Kim13 1National Emergency Medical Center, National Medical Center, Seoul, Republic of Korea 2 Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA 3 Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China 4National Heart Centre Singapore and Duke-NUS Medical School, National University of Singapore, Singapore 5 Department of Radiology and Imaging, Fortis Escorts Heart Institute, New Delhi, India 6 Department of Cardiology, NHO Shikoku Cancer Center, Matsuyama, Japan 7 Department of Cardiology, Chiang Mai University, Chiang Mai, Thailand 8 Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan 9Radiology Center, Bach Mai Hospital, Hanoi, Vietnam 10 Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea 11 Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 12 Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea 13 Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea Coronary CT-derived fractional flow reserve (CT-FFR) is a noninvasive alternative to invasive FFR for assessing the hemodynamic significance of coronary artery stenosis. CT-FFR uses routinely acquired coronary CT angiography (CCTA) with artificial intelligence and computational fluid dynamics to estimate pressure gradients, thereby supporting clinical decisionmaking without procedural risk. Adoption and implementation vary widely across regions. In Asia, South Korea exclusively uses HeartMedi+, which enables rapid analysis, streamlined workflow integration, and high user satisfaction. Japan relies primarily on FFRCT, which has national reimbursement and significantly influences treatment strategies, reducing unnecessary invasive procedures. Hong Kong, Singapore, Taiwan, Thailand, and Vietnam remain in early or exploratory phases due to cost, reimbursement, and infrastructure barriers. In the United States, CT-FFR is guideline-endorsed and reimbursed, where HeartFlow is the most widely used, supported by robust clinical validation and outcome data. Despite regional variability, CTFFR offers a noninvasive solution that enhances patient management, reduces unnecessary invasive testing, and is poised for broader clinical integration as technology and validation advance. Keywords: Coronary CT angiography; Fractional flow reserve; CT-FFR; Coronary artery disease; Asian Society of Cardiovascular Imaging INTRODUCTION Invasive fractional flow reserve (FFR) is the reference standard for assessing coronary artery stenosis, yet it is invasive and underused [1] . Non-invasive coronary physiological assessment using CT-FFR has emerged as a promising alternative to eliminate catheter-related risks [2-7]. CT-FFR leverages routinely acquired coronary CT angiography (CCTA) by applying artificial intelligence (AI)-based segmentation with computational fluid dynamics (CFD) and Received: August 18, 2025 Revised: October 27, 2025 Accepted: October 30, 2025 Corresponding author: Cherry Kim, MD, PhD, Department of Radiology, Korea University Ansan Hospital, 123

FAQs

What is CT-FFR and how does it differ from invasive FFR?

CT-FFR is a noninvasive method derived from coronary CT angiography to assess the hemodynamic significance of coronary stenosis. It estimates pressure gradients using AI-based analysis and computational fluid dynamics, avoiding invasive catheter-related risk.

Which technology is mainly used for CT-FFR in South Korea and what impact does it have?

South Korea exclusively uses HeartMedi+, which enables rapid analysis, streamlines workflow integration, and results in high user satisfaction.

Why is CT-FFR adoption at different stages across Asia and the United States?

Regional differences are driven by factors such as cost, reimbursement policies, and available infrastructure. The United States benefits from guideline endorsement and reimbursement, while several Asian regions remain early or exploratory.

Sep 30, 2026

Uploaded by Fans