Milestone' for new noninvasive heart test medicare now covers FFR-CTcoronary artery test

The test employs CT scans to calculate blood flow through coronary arteries. In some patients, this may eliminate the need for an invasive coronary angiogram.

The test, called fractional flow reserve-computed tomography (FFR-CT), was developed by HeartFlow, Inc. FFR-CT has been approved by the Food and Drug Administration, and the Centers for Medicare & Medicaid Services began paying for the technical component of the test, beginning January 1, 2018. Some major private insurers already have begun covering the test, and others are expected to follow Medicare's lead.

"Medicare coverage is a major milestone," said Loyola Medicine cardiologist Mark Rabbat, MD. "Millions of Americans now can potentially benefit from this game-changing technology."

Loyola University Medical Center was the first hospital in Illinois and the second in the country to offer FFR-CT_. Loyola has performed the test on more than 400 patients. Also, Dr. Rabbat is first author of a report in the Journal of Cardiovascular Computed Tomography that describes how to interpret and report the FFR-CT exam.

Dr. Rabbat said FFR-CT can answer important clinical questions such as whether plaque in a coronary artery is restricting blood flow, thereby helping determine whether a patient would require medications, stenting or bypass surgery.

More than 16 million adults in the United States have coronary artery disease. The condition occurs when a buildup of plaque narrows arteries that supply oxygen-rich blood to heart muscle. Reduced blood flow to heart muscle can cause angina (chest pain) and shortness of breath. If an artery becomes completely blocked, a patient can suffer a heart attack.

The measure of blood flow is called fractional flow reserve (FFR). Until now, the standard test for measuring FFR involved an invasive angiogram. A catheter (thin tube) is inserted in the groin or arm and guided to the heart. A thin wire then is guided through the catheter to the blockage. A sensor near the tip of the wire measures blood pressure. If blood flow is reduced, the blood pressure downstream from the blockage also will be reduced.

The new FFR-CT technique is noninvasive. CT scans create a digital 3D model of the arteries leading to the heart. Powerful computer models then simulate the flow within those arteries to assess whether blood flow has been restricted by any narrowings. A color-coded map helps physicians determine, vessel by vessel, if sufficient blood is flowing to the heart.

"In many patients, FFR-CT can safely eliminate the need for an invasive angiogram," Dr. Rabbat said. "In other cases, it can detect heart disease that standard-of-care tests are missing."