We read the meta-analysis by Gonzalez et al, published in the November issue of the American Journal of Cardiology . This meta-analysis compared the diagnostic performances of coronary computed tomography angiography (CCTA), computed tomography perfusion, and computed tomography–based fractional flow reserve (CT-FFR).

CT-FFR has been shown to significantly improve diagnostic assessment compared with CCTA alone. However, owing to time consuming offsite calculations, the clinical impact of this innovative approach remains unclear. Thus, a solution for physician-driven CT-FFR derivation using regular onsite workstations was developed, as noted by the first results produced by our research group and Coenen et al. This new CT-FFR algorithm applies reduced order models for more expeditious calculations.

We note that the study by Coenen et al was not included in the current meta-analysis by Gonzalez et al. Inclusion of this study might have strengthened the study, as it would have added 106 patients and 189 vessels, reporting a pooled sensitivity of 81.3% and 87.5%, a pooled specificity of 37.6% and 65.1%, a pooled positive predictive value of 48.9% and 64.8%, and a pooled negative predictive value of 73.2% and 87.7% for CCTA and CT-FFR on a per-vessel level, respectively. Furthermore, a discussion of the various CT-FFR approaches currently in exploration would have enriched the study.

Nevertheless, the investigators of the meta-analysis are to be congratulated for their work, as it constitutes a well-written study and covers a highly topical and recurrent subject of discussion that will likely be very interesting for readers.