Deep Learning and Fluid Dynamics On-Site CT-FFR Solution Compared to Off-Site FFRct and Invasive FFR (JIMG April 2026)-Article: Deep Learning and Fluid Dynamics On-Site CT-FFR Solution Compared to Off-Site FFRct and Invasive FFR

Article: Deep Learning and Fluid Dynamics On-Site CT-FFR Solution Compared to Off-Site FFRct and Invasive FFR

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This single-center prospective study assessed whether an on-site computed tomography–derived fractional flow reserve (CT-FFR) tool (xFFR; GE HealthCare), combining deep learning and fluid dynamics, can match the performance of off-site HeartFlow FFRct and the invasive gold standard (invasive FFR/iFFR) for evaluating hemodynamically significant coronary artery disease (CAD).<br /><br />From 1,663 referred symptomatic patients, 289 met eligibility criteria, and 250 were ultimately analyzable with xFFR (xFFR processing failed in 39 patients due to prototype/compatibility issues rather than the concept itself). Participants were mostly male (76%) with a mean age of 65 years and intermediate-to-high pretest CAD likelihood. All underwent coronary CT angiography (CTA), off-site FFRct, and invasive coronary angiography with iFFR (performed mainly for 30%–80% stenoses; ≥80% stenoses/occlusions were assumed functionally significant).<br /><br />Functionally significant CAD (≤0.80) was found in 56.6% by xFFR, 54% by FFRct, and 48% by iFFR. On a per-patient basis, xFFR showed sensitivity 95%, specificity 81%, and accuracy 88% versus iFFR. Overall discrimination was excellent and similar to FFRct (AUC 0.91 vs 0.89; P=0.274), but xFFR performed better for left anterior descending artery assessment (AUC 0.96 vs 0.84; P=0.001). Agreement with iFFR was good (Spearman ρ≈0.61–0.67; Cohen’s κ≈0.78 overall; strongest in LAD). In discordant cases, xFFR more often matched iFFR than FFRct.<br /><br />A key advantage was speed and workflow integration: mean xFFR processing time was ~8±3.4 minutes on-site, compared with ~22 hours off-site turnaround for FFRct. The authors conclude xFFR is a fast, reproducible on-site alternative to off-site CT-FFR, warranting broader validation.

Keywords

computed tomography–derived fractional flow reserve

CT-FFR

xFFR

GE HealthCare

HeartFlow FFRct

invasive FFR

instantaneous wave-free ratio (iFFR)

coronary artery disease

coronary CT angiography

on-site processing time