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FFR-CTSURE-CTNCT07544277

Spectral and Ultra High Resolution CT Systems for Non-Invasive Detection of Myocardial Ischemia: Stress CT Perfusion VS. FFR-CT

An observational study of FFR-CT and CT Angiography, run by IRCCS San Raffaele at 2 sites in Italy.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Coronary Computed Tomography angiography (CCTA) gained a pivotal clinical role for excellent sensitivity in rule-out CAD, but has limited specificity for a tendency to overestimate stenoses and for the lack of information about… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
FFR-CT, CT Angiography, CT Perfusion
How many people
142 participants
Where
2 sitesItaly
Study dates
1 Sep 2026to 1 Sep 2029
How long will I take part?
24 Months
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: 142 patients (age>18 years old) referred to our hospitals for elective CCTA for ruling out CAD and CCTA evidence of moderate stenosis (50-69%) requiring functional assessment according to ESC guidelines (1) because is known that not all anatomical stenosis in the range of moderate (50-69%) are haemodynamically significant (2) or induce myocardial ischaemia (3).

Who may be able to join

  • Patient referred to our hospitals for elective CCTA for ruling out CAD
  • CCTA evidence of moderate stenosis (50-69%) requiring functional assessment according to ESC guidelines

Who cannot join

  • hemodynamically unstable conditions,
  • previous revascularization,
  • myocardial infarction,
  • obesity (BMI>40 kg/m2),
  • renal insufficiency (GFR<30 mL/min),
  • atrial fibrillation or other significant arrhythmias; and
Show all 9Show fewer
  • other overt cardiovascular diseases affecting CTP performance (e.g., heart failure, severe valvular regurgitation),
  • pregnancy and breastfeeding,
  • contraindications to iodinated contrast agents or regadenoson.

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Anna Palmisano, Medicine and Surgery contact

+39 3200985665

palmisano.anna@hsr.it

Davide Vignale, Medicine and Surgery contact

+39 3480521191

vignale.davide@hsr.it

Italy2 sites
  • IRCCS Ospedale San Raffaele

    Milan

  • Azienda Ospedaliero-Universitaria Sant'Andrea

    Roma, RM, 00189

    Damiano Caruso, Medicine and Surgery

Other trials in Italy

About this study

Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Coronary Computed Tomography angiography (CCTA) gained a pivotal clinical role for excellent sensitivity in rule-out CAD, but has limited specificity for a tendency to overestimate stenoses and for the lack of information about their hemodynamic impact. Fractional Flow Reserve derived from CT (FFR-CT) and stress CT perfusion (CTP) have been recently proposed to complement CCTA in the non-invasive assessment of myocardial ischemia, increasing the specificity and avoiding unnecessary catheterization. However, on energy-integrating (EID)-CT, FFR-CT has suboptimal performance, while CTP is affected by high radiation exposure. Both these approaches may benefit by the introduction of the new Photon Counting Detector (PCD)-CT technology, but data completely lacks. Aim of the study is to assess the performance of PCD-CT in the identification of significant CAD combining CCTA with FFR-CT and spectral CTP.

Keywords
FFR-CT, Coronary CT angiography, CT Perfusion, Coronary Arterial Disease (CAD)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Diagnostic accuracy of CCTA, CCTA plus FFR-CT, and CCTA plus spectral stress CT perfusion in the detection of hemodynamically relevant coronary stenosis

    CCTA-derived stenosis and plaque characterization; CT-FFR values from commercial and in-house solutions; CTP-derived iodine uptake measurement; invasive FFR as reference standard. Comparison of off-site versus on-site CT-FFR solutions determined against invasive FFR.

    Measured: 36 months

  2. Evaluation of rest spectral CT perfusion for the assessment of haemodynamic significance of stenosis

    Coronary stenosis severity at CCTA; myocardial iodine uptake at baseline, rest, and stress CTP; diagnostic performance of iodine uptake values against invasive FFR.

    Measured: 36 months

  3. Identification of geometric features from PCD-CT ultra high resolution CCTA associated to plaque-specific ischemia at invasive FFR.

    Blinded analysis of baseline CCTA for qualitative and quantitative plaque characteristics, with correlation to invasive FFR. Inter-rater agreement assessment between two expert readers. Deep learning-based radiomic feature extraction from plaques and vessel walls. Development of a data-driven feature selection pipeline to predict hemodynamically significant stenosis from CCTA data, using invasive FFR as reference.

    Measured: 36 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Apr 2026
  2. Study start1 Sep 2026 (estimated)
  3. Primary completion1 Apr 2029 (estimated)
  4. Study completion1 Sep 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
142 participants (estimated)
Target duration
24 Months
IDs, dates and publications
ClinicalTrials.gov ID
NCT07544277
Sponsor's protocol ID
GR-2024-12380180
Acronym
SURE-CT
Status last verified
Apr 2026
First submitted
15 Apr 2026
Last updated
21 Sep 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Correction to: 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2025 Apr 22;46(16):1565. doi: 10.1093/eurheartj/ehaf079. No abstract available.

    PubMed 39982387
  • De Santis D, Del Gaudio A, Santangeli C, Fanelli F, Pacelli F, Capece Minutolo Del Sasso L, Zerunian M, Polici M, Polidori T, Pucciarelli F, Marin D, Laghi A, Caruso D. Every Drop (Photon) Counts: Current Applications and Future Challenges of Photon-Counting Detector CT in Abdominal Imaging. Invest Radiol. 2025 Oct 1;60(10):647-657. doi: 10.1097/RLI.0000000000001178.

    PubMed 40138651
  • Caruso D, Eid M, Schoepf UJ, Jin KN, Varga-Szemes A, Tesche C, Mangold S, Spandorfer A, Laghi A, De Cecco CN. Dynamic CT myocardial perfusion imaging. Eur J Radiol. 2016 Oct;85(10):1893-1899. doi: 10.1016/j.ejrad.2016.07.017. Epub 2016 Aug 3.

    PubMed 27510361
  • Caruso D, DE Santis D, Schoepf UJ, Zerunian M, Eid M, Varga-Szemes A, Tesche C, Duguay TM, Laghi A, DE Cecco CN. CT myocardial perfusion: state of the science. Minerva Cardioangiol. 2017 Jun;65(3):252-264. doi: 10.23736/S0026-4725.16.04281-X. Epub 2016 Dec 13.

    PubMed 27958693
  • Ghizzoni G, Ancona MB, Romano V, Bellini B, Ferri L, Russo F, Vella C, Gentile D, Chionchio G, Macelletti V, Ancona F, Agricola E, Palmisano A, Esposito A, Montorfano M. Mind the "commissural drop" when crossing the aortic valve! Catheter Cardiovasc Interv. 2023 Sep;102(3):538-541. doi: 10.1002/ccd.30763. Epub 2023 Jul 18. No abstract available.

    PubMed 37464968
  • Bellini B, Romano V, Zanda G, Iannopollo G, De Ferrari T, Bijlsma E, Napoli F, Vella C, Gentile D, Ghizzoni G, Ferri LA, Russo F, Ancona MB, Ancona F, Agricola E, Palmisano A, Esposito A, Montorfano M. Clinical Outcomes of Patients With Bicuspid Aortic Valve Undergoing a Targeted Transcatheter Aortic Valve Replacement Approach: The LIRA Method. Can J Cardiol. 2025 May;41(5):831-839. doi: 10.1016/j.cjca.2024.12.006. Epub 2024 Dec 10.

    PubMed 39667491
  • Ferri LA, Ancona MB, Papageorgiou C, Vella C, Capuano S, Romano V, Russo F, Bellini B, Zanda G, Gentile D, Ghizzoni G, Napoli F, Federico F, Agricola E, Palmisano A, Esposito A, Montorfano M. Computed tomography derived predictors of left ventricular obstruction after TAVR. Int J Cardiol. 2025 Mar 1;422:132956. doi: 10.1016/j.ijcard.2024.132956. Epub 2025 Jan 5.

    PubMed 39765320
  • Palmisano A, Vignale D, Boccia E, Nonis A, Gnasso C, Leone R, Montagna M, Nicoletti V, Bianchi AG, Brusamolino S, Dorizza A, Moraschini M, Veettil R, Cereda A, Toselli M, Giannini F, Loffi M, Patelli G, Monello A, Iannopollo G, Ippolito D, Mancini EM, Pontone G, Vignali L, Scarnecchia E, Iannacone M, Baffoni L, Sperandio M, de Carlini CC, Sironi S, Rapezzi C, Antiga L, Jagher V, Di Serio C, Furlanello C, Tacchetti C, Esposito A. AI-SCoRE (artificial intelligence-SARS CoV2 risk evaluation): a fast, objective and fully automated platform to predict the outcome in COVID-19 patients. Radiol Med. 2022 Sep;127(9):960-972. doi: 10.1007/s11547-022-01518-0. Epub 2022 Aug 29.

    PubMed 36038790
  • Esposito A, Palmisano A, Antunes S, Colantoni C, Rancoita PMV, Vignale D, Baratto F, Della Bella P, Del Maschio A, De Cobelli F. Assessment of Remote Myocardium Heterogeneity in Patients with Ventricular Tachycardia Using Texture Analysis of Late Iodine Enhancement (LIE) Cardiac Computed Tomography (cCT) Images. Mol Imaging Biol. 2018 Oct;20(5):816-825. doi: 10.1007/s11307-018-1175-1.

    PubMed 29536321
  • Palmisano A, Vignale D, Tadic M, Moroni F, De Stefano D, Gatti M, Boccia E, Faletti R, Oppizzi M, Peretto G, Slavich M, Sala S, Montorfano M, Agricola E, Margonato A, De Cobelli F, Gentile F, Robella M, Cortese G, Esposito A. Myocardial Late Contrast Enhancement CT in Troponin-Positive Acute Chest Pain Syndrome. Radiology. 2022 Mar;302(3):545-553. doi: 10.1148/radiol.211288. Epub 2021 Dec 7.

    PubMed 34874200
  • Muscogiuri G, Palumbo P, Kitagawa K, Nakamura S, Senatieri A, De Cecco CN, Gershon G, Chierchia G, Usai J, Sferratore D, D'Angelo T, Guglielmo M, Dell'Aversana S, Jankovic S, Salgado R, Saba L, Cau R, Marra P, Di Cesare E, Sironi S. State of the art of CT myocardial perfusion. Radiol Med. 2025 Mar;130(3):438-452. doi: 10.1007/s11547-024-01942-4. Epub 2024 Dec 20.

    PubMed 39704963
  • Soschynski M, Storelli R, Birkemeyer C, Hagar MT, Faby S, Schwemmer C, Nous FMA, Pugliese F, Vliegenthart R, Schlett CL, Nikolaou K, Krumm P, Nieman K, Bamberg F, Artzner CP. CT Myocardial Perfusion and CT-FFR versus Invasive FFR for Hemodynamic Relevance of Coronary Artery Disease. Radiology. 2024 Aug;312(2):e233234. doi: 10.1148/radiol.233234.

    PubMed 39162632
  • Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM; QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011 Oct 18;155(8):529-36. doi: 10.7326/0003-4819-155-8-201110180-00009.

    PubMed 22007046
  • Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD Statement. BMC Med. 2015 Jan 6;13:1. doi: 10.1186/s12916-014-0241-z.

    PubMed 25563062
  • Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L, Irwig L, Levine D, Reitsma JB, de Vet HC, Bossuyt PM. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016 Nov 14;6(11):e012799. doi: 10.1136/bmjopen-2016-012799.

    PubMed 28137831

Questions about this trial

What is this clinical trial studying?

An observational study of FFR-CT and CT Angiography, run by IRCCS San Raffaele at 2 sites in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 21 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Anna Palmisano, Medicine and Surgery (+39 3200985665, palmisano.anna@hsr.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Diagnostic accuracy of CCTA, CCTA plus FFR-CT, and CCTA plus spectral stress CT perfusion in the detection of hemodynamically relevant coronary stenosis (time frame: 36 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07544277, which also lists 19 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Sep 2026.

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