Stress Less

with Precision Heart care

Updated ACC/AHA Guidelines Highlight Coronary CTA + FFRCT Pathway

For the first time since 2012, the American College of Cardiology (ACC) and American Heart Association (AHA) Guidelines for the Evaluation and Diagnosis of Chest Pain have been updated. The 2021 Guidelines now highlight use of Coronary CTA + FFRCT as a front-line pathway1, a decision that was supported by numerous clinical studies indicating that this pathway provides higher diagnostic accuracy compared to other non-invasive diagnostic tests2, provides long-term outcomes3 and is a "dominant strategy".4

Can a CT + HeartFlow
Pathway Help You
and Your Patients?

The Highlights

The newly updated ACC/AHA Guidelines reflect the growing support for a Coronary CTA + FFRCT pathway across the world–including in Europe (2019 ESC Guidelines), the UK (2016 NICE Guidelines) and Japan (2018 JCS Guidelines)–suggesting a revolutionary shift in the diagnosis and management of coronary artery disease (CAD) is underway.

The Guidelines Demonstrate:
  • Using Coronary CTA + FFRCT across a broad patient population--including those with known or suspected CAD and stable or acute chest pain--enables physicians to guide clinical diagnosis and revascularization decisions.
  • Using stress testing fills a diagnostic role and is not called out for guiding treatment decisions

Elevating Coronary CT Angiography
The only Class 1 non-invasive test with Level A evidence

Elevating Coronary CT Angiography
The only Class 1 non-invasive test with Level A evidence

Coronary CTA (CCTA) has been elevated to be the only Class I test with Level A evidence for use as a first-line tool to evaluate patients exhibiting symptoms of CAD: "it is effective for diagnosis of CAD, risk stratification, and guiding treatment decisions". It is also appropriate after inconclusive functional tests, such as nuclear tests and stress echos, when considering revascularization strategies.

CCTA provides 98% negative predictive value and is a definitive test to help rule out the possibility of CAD.5

Recognizing FFRCT
Class 2a with Level B evidence

Recognizing FFRCT
Class 2a with Level B evidence

FFRCT is now included in the guidelines to support the further evaluation of patients with a coronary artery disease of uncertain physiologic significance. FFRCT provides actionable information that enables physicians to non-invasively diagnose "vessel-specific ischemia and guide decision-making regarding" revascularization in stenoses of 40-90%.

As the only commercially available FFRCT product, the HeartFlow FFRCT Analysis provides higher diagnostic performance and accuracy than other non-invasive tests.2

The Impact

To date, more than 170,000 patients have benefited from a HeartFlow Analysis, but this is only a fraction of the 18+ million people living with coronary artery disease (CAD) in the US.6 Together, we can help take the stress out of the diagnosis and management of CAD and help revolutionize precision heart care.


Patients can stress less knowing that the most advanced technology available has been used to determine that either their CAD has been safely ruled out as a possible cause of their symptoms or that they are receiving the optimal treatment if CAD has been identified.

The CT+HeartFlow pathway will:

  • Provide a clearer picture of their heart health
  • Help explain symptoms, providing peace of mind
  • Minimize hospital visits necessitated by repetitive cardiac testing
  • Limit testing-related radiation exposure


Physicians can stress less knowing that they have the clarity and confidence to precisely diagnose and treat their patients with CAD, benefiting from a single pathway that provides both anatomic and physiologic information in a simple-to-understand 3D model.

The CT+HeartFlow pathway will:

  • Provide the highest diagnostic accuracy2
  • Diagnose CAD that can be missed by stress tests2
  • Reduce diagnostic caths not resulting in revascularization7
  • Help provide certainty to the most relevant questions:
    • Does my patient have CAD?
    • How severe is my patient’s CAD?
    • What is the appropriate treatment for my patient?


Hospital administrators can stress less knowing that their sites are delivering the best guideline-directed care, backed by major societies, payors, CMS and a growing coalition around the world all dedicated to addressing the most prevalent and deadly disease in the world.

The CT+HeartFlow pathway will:

  • Ensure the right patients are identified to receive appropriate treatment at the right time
  • Enable revolutionary technology to optimize care in a cost-effective manner
  • Provide an improved and simplified patient experience

The Evidence

The 2021 ACC/AHA Guidelines are built upon extensive evidence demonstrating the value of non-invasive cardiac testing. In particular, this evidence substantiates the long-term benefits of the CT+HeartFlow pathway, including:

High patient and provider confidence to rule out CAD using CTA with a 98% negative predictive value5 and to accurately diagnose the physiologic significance of disease, when paired with the HeartFlow Analysis.

Improved long-term patient outcomes when coronary CTA is used to evaluate patients with suspected or known CAD.3

Adding physiologic insight to anatomy informs treatment and leads to better patient outcomes.8

Clinical decision making and workflow efficiencies improve resulting in long-term improved outcomes and a lower cost of care with the CT+HeartFlow pathway.9

How do non-invasive
CAD tests compare?

CT-Flow Pathway
CT-Flow Pathway
SPECTStress EchoCoronary CTAHeartFlow Analysis
Common QuestionsA SPECT sampleA Stress Echo sampleA Coronary CTA sampleA Coronary CT Flow sample
Does my patient have CAD?XXXX
Do the vessels have plaque?XX
Where are the coronary artery specific stenoses?XX
Is there possible ischemia?XXX
What are the lesion-specific functional limitations?X
Which vessels may benefit from PCI/CABG/OMT?X
Is prognostic information provided?XXXX
Diagnostic Performance* Sensitivity: 0.42
Specificity: 0.97
AUC: 0.792
Sensitivity: 0.77
Specificity: 0.75
AUC: 0.7010
Sensitivity: 0.68
Specificity: 0.83
AUC: 0.832
Sensitivity: 0.90
Specificity: 0.86
AUC: 0.942
Disadvantages2, 10-14 Low sensitivity;
high rate of false negatives; higher radiation exposure;
lacks anatomic data
Often requires
additional testing;
lacks anatomic data
High sensitivity can lead to overutilization of invasive testing
when not paired with
functional information
Requires CCTA;
Currently not as well known as other tests
Advantages2, 10-14Accessible;
high specificity;
standard of care
no radiation
Better long-term
outcomes than
usual care testing;
lower radiation;
provides anatomic data
More accurate than
other non-invasive tests;
provides anatomic and
functional information;
lower radiation; single
patient visit

* Diagnostic performance of SPECT, CCTA and FFRCT evaluated in a head-to-head comparison for the identification of ischaemia.

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Helpful Resources

Are you ready to make the change? Whether you are an avid user of stress tests and curious to learn more about the benefits of the CT + HeartFlow pathway, are looking to build a CT program and need help figuring out where to start or have a growing program but need to better understand how physiology fits in, contact our team. We’re ready to help. In the meantime, review some of the helpful resources below to learn more.

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  1. Gulati, et al. 2021 AHA/ACC/ASE/CHES/SAEM/SCCT/SCMR Guideline for the Evaluation & Diagnosis of Chest Pain. Circulation.
  2. Driessen, et al. J Am Coll Cardiol 2019; Norgaard, et al, Euro J Radiol 2015.
  3. Nørgaard, et al. J Am Coll Cardiol 2018., Ihdayhid, et al. Radiology 2019
  4. Karády, et al. JAMA Open. 2020.
  5. Meijboom, et al. J Am Coll Cardiol 2008. Budoff, et al. J Am Coll Cardiol 2008. Miller, et al. N Engl J Med 2008.
  7. Douglas, et al. J Am Coll Cardiol 2016
  8. Parikh, et al. J Am Coll Cardiol 2020.
  9. The FORECAST Trial, presented at TCT Connect 2020. Douglas, et al. NEJM 2015. Curzen, et al. JACC CV Imag 2016. Patel, et al. JACC CV Imag 2019. Newby, et al. NEJM 2018. Douglas, et al. JACC 2016. Lu, et al. JACC CV Imag 2017.
  10. Danad, et al., Euro Heart J 2017.
  11. Melikian, et al. JACC: Cardiovasc Interv 2010; Jung, et al. Euro Heart J 2008. Koo, et al. J Am Coll; Cardiol 2011. Min, et al. JAMA 2012. Nørgaard, et al. J Am Coll Cardiol 2014.
  12. Patel, et al. J Am Coll Cardiol 2019.
  13. Stocker, et al. Euro Heart J 2018.
  14. Curzen, N.P., et al., J Am Coll Cardiol 2016. Newby D.E., et al. N Engl J Med 2018.

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