The heart is a muscle — how well is yours working?

For 1 in 20 of us, it may not be working as efficiently as it should. That’s the estimated proportion of adults age 20 and older in the United States with coronary artery disease, the Centers for Disease Control and Prevention reports.

In fact, heart disease is the No. 1 killer in the U.S. Every 33 seconds someone dies from heart disease.

Dr. Jack Xu

And if you’re someone who’s worried about heart disease and discuss it with your doctor, there’s a newer test for evaluating your risk called CT-FFR. Here to explain is Novant Health cardiologist Dr. Jack Xu, (pronounced shu) of Novant Health Cardiology – Kimel Park Main.

What is CT-FFR?

CT-FFR stands for Computed Tomography-Fractional Flow Reserve. CT-FFR is an extra layer of analysis that can be done when your doctor has a concern about blockage.

It uses AI and other analyses to give us a better idea of how significant blockages are.

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Who is CT-FFR used for?

CT-FFR is used for patients who are experiencing symptoms of heart disease, or who have risk factors for heart disease like high blood pressure, high cholesterol, tobacco use, family history of heart disease, and diabetes. Sometimes we will order CT-FFR for patients who have had an unclear or borderline stress test.

What happens during CT-FFR?

First, you have an outpatient imaging test called a CT coronary angiogram (the “CT” in CT-FFR). On testing day, you’re evaluated to make sure your heart rate is slow enough to ensure we get good images. If it’s not, we give you medicine to slow your heart rate so we don’t get blurry images.

Then you come into the scanning room, lay on a table, and get an IV in your arm. This IV contains dye that will help your blood vessels show up more clearly on the images. Then we take pictures.

CT is like a special X-ray that moves in a circle around the body, then creates a model on the computer to let us see what is going on with your heart arteries and if there are signs of possible blockages.

It usually takes about 10 minutes, although it can take a few hours if we need to slow your heart rate first.

If we see some blockage, we will send your CT data off-site for HeartFlow analysis. This technology makes a 3D model of your heart and coronary arteries. We then examine that model to see if any blockages are “hemodynamically significant.”

This means that we measure the flow of your blood before it hits the blockage and then after to determine how much the blockage is limiting your blood flow and whether there is enough blood flowing to your heart.

What’s the benefit of CT-FFR compared to other screenings?

Historically, we have also used stress tests to screen for coronary artery disease. However, stress tests only look at how the heart is pumping and how it moves. They don’t let us see any visualization of the direct arteries, and a stress test can only tell us if you have 50% or more blockage.

CT-FFR lets us see the exact blockage you have. Before CT-FFR came along, we also did a procedure called heart catheterization. It gave us excellent information about blockages, but we had to place a catheter through your artery into your heart arteries. CT-FFR gives us the same information, in a much less invasive way since it involves only an IV.

Why is that helpful information?

Let’s say I see someone with mild blockage, like 40% blockage. My goal is to prevent that from developing into a heart attack. I don't want that 40% blockage to go into a 90% blockage.

So I will have a conversation with my patient. “So, you have mild blockage, but you're eating poorly and smoking. Your blockage is mild now and not that concerning, but if you keep going with your lifestyle and don't take your blood-pressure medications now, chances are it's probably going to get worse.” I feel like even if they have a 20% blockage, we can still have a good discussion in order to give them the best chance of not having a future blockage.

If they have 80% blockage and their CT-FFR is positive (which means the blockage is hemodynamically significant), they will either need medications or a heart catheterization procedure, which can determine if they need a stent or bypass surgery.

If they are also having symptoms, we will set them up for a procedure to put a stent in. The CT-FFR allows us to plan that procedure better because we know where the artery is blocked and where we will need to put the stent in.

Do I need CT-FFR?

If you are experiencing symptoms like chest pain or shortness of breath, or symptoms like nausea, indigestion or fatigue, bring those up with your primary care provider. Your provider can help you figure out if these are heart-related symptoms or if they are something else, like acid reflux. Also, you need to inform your doctor of your risk factors for coronary artery disease.

If your doctor decides you need CT-FFR, it is covered by most insurance companies.