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

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 decision-making 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, CT-FFR offers a noninvasive solution that enhances patient management, reduces unnecessary invasive testing, and is poised for broader clinical integration as technology and validation advance.