Comparative Performance of Non-Invasive Fractional Flow Reserve Derived from Ultra-High-Resolution Computed Tomography Versus Invasive Fractional Flow Reserve

International Journal of Cardiology | Vol. 17, No. 8, August 2026 | pp. 25–32

DOI: 10.46882/2026/IJC/001916

Original Research Article

Comparative Performance of Non-Invasive Fractional Flow Reserve Derived from Ultra-High-Resolution Computed Tomography Versus Invasive Fractional Flow Reserve

Hiroshi Tanaka¹, Kenji Sato¹

¹ Department of Cardiology, Tokyo University Hospital, Tokyo, Japan

Abstract:
Accurate non-invasive assessment of coronary artery stenosis severity is vital to optimize patient selection for invasive revascularization. This diagnostic accuracy study evaluated a novel ultra-high-resolution computed tomography-derived fractional flow reserve (UHR-FFRct) software platform utilizing cloud-based computational fluid dynamics against standard invasive fractional flow reserve (FFR). A total of 310 symptomatic patients with suspected coronary artery disease (CAD) scheduled for elective coronary angiography were prospectively enrolled. All participants underwent pre-procedural ultra-high-resolution coronary CT angiography. Coronary lesions were considered hemodynamically significant if the UHR-FFRct or invasive FFR value was less than or equal to 0.80. Invasive FFR measurements were successfully obtained in 385 separate vessels. On a per-vessel analysis, UHR-FFRct demonstrated an overall diagnostic sensitivity of 93.5% (95% Confidence Interval [CI]: 89.2%-96.4%), a specificity of 89.1% (95% CI: 84.7%-92.6%), and an accuracy of 91.2%. The area under the receiver operating characteristic curve was 0.94 (p < 0.001). The mean absolute difference between UHR-FFRct and invasive FFR was 0.03 (± 0.01). Diagnostic performance remained robust within calcified plaques, showing a minor drop in specificity to 84.6%. In conclusion, UHR-FFRct offers exceptionally high diagnostic accuracy and strong correlation with invasive FFR values. Implementing this advanced non-invasive computational fluid framework can safely reduce the rate of diagnostic-only invasive coronary angiograms and streamline clinical decision-making pathways for complex coronary lesions.

Keywords: Computed tomography angiography, Fractional flow reserve, Computational fluid dynamics, Coronary artery disease, Myocardial ischemia, Diagnostic accuracy

Received: May 14, 2026; Revised: June 18, 2026; Accepted: July 05, 2026; Published: August 07, 2026

Citation: Tanaka H, Sato K. Comparative Performance of Non-Invasive Fractional Flow Reserve Derived from Ultra-High-Resolution Computed Tomography Versus Invasive Fractional Flow Reserve. International Journal of Cardiology, 2026; 17(8): 25–32. DOI: 10.46882/2026/IJC/001916

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