1.Coronary CT Angiography-Derived Fractional Flow Reserve in Asia and the United States: 2025 Status Update
Woo Jin AHN ; Maros FERENCIK ; Ming-Yen NG ; Liang ZHONG ; Mona BHATIA ; Akira KURATA ; Pannipa SUWANNASOM ; Yung-Liang WAN ; Trang Ngoc NGUYEN ; Suyon CHANG ; Sung Mok KIM ; Hwan Seok YONG ; Cherry KIM
Korean Journal of Radiology 2026;27(1):27-33
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 FFR CT, 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.
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