Attitudes and Willingness of Cardiothoracic Group Physicians in the Cardiovascular and Radiology Departments toward the Adjuvant Use of CT-Derived Fractional Flow Reserve in the Diagnosis of Coronary Artery Disease.

Abstract

Background: The diagnosis of coronary artery disease (CAD) has traditionally relied on invasive coronary angiography (ICA), a method with inherent risks. As a noninvasive technique, computed tomography-derived fractional flow reserve (CT-FFR) can integrate both anatomical and functional assessments of the coronary arteries, identifying hemodynamically significant stenosis and thereby reducing unnecessary invasive procedures. Although its clinical value has been demonstrated, its widespread clinical adoption is constrained by physician perception.

Objective: To quantify the professional attitudes and willingness to adopt CT-FFR for clinical application among cardiologists and radiologists, and to identify the key determinants influencing their positivity.

Methods: A cross-sectional survey was conducted from May to June 2023 across five provinces and cities in China. Data were collected from 265 cardiothoracic physicians using a validated, structured questionnaire (Cronbach's α = 0.884). The questionnaire assessed two core dimensions using a five-point Likert scale: "Attitude" (15 questions) and "Willingness" (eight questions). Higher scores indicated more positive attitudes or willingness.

Results: The survey was completed by 265 physicians, with overall attitudes being positive. The median scores for the attitude and willingness dimensions were 51 (interquartile range: 48, 55) and 31 (interquartile range: 29, 32), respectively, with a significant positive correlation between them (r = 0.571, p < 0.001). While over 60% of physicians acknowledged that CT-FFR could prevent unnecessary invasive procedures, 38.1% still expressed concerns about its diagnostic accuracy. Logistic regression analysis showed that physicians working in specialized cardiovascular hospitals held more positive attitudes (OR = 3.085, p = 0.017). Multivariable analysis further confirmed that a positive attitude was the strongest independent predictor driving willingness to adopt (OR = 6.280, p < 0.001).

Conclusion: Participants' belief in the development potential of CT-FFR was positively associated with their willingness to learn, receive training, consider improvements, and participate in clinical research involving CT-FFR.