Abstract Body (Do not enter title and authors here): Background:
Accurate non-invasive functional testing is essential for managing stable coronary artery disease (CAD). While Dobutamine Stress Echocardiography (DSE) is widely used, CT-Derived Fractional Flow Reserve (CT-FFR) combines anatomical and physiological data, offering potential diagnostic advantages.

Objective:
To systematically evaluate the diagnostic performance of CT-FFR compared to DSE for identifying hemodynamically significant coronary stenoses, using invasive FFR as the reference standard.

Methods:
A comprehensive literature search of PubMed, Embase, and Cochrane databases identified studies from 2010 to 2025 comparing CT-FFR and DSE in patients with stable CAD. Studies were included if they involved ≥30 patients and used invasive FFR as the reference. Extracted data included sensitivity, specificity, and methodological parameters. Risk of bias was assessed using the QUADAS-2 tool. Meta-analysis was not performed due to heterogeneity.

Results:
Twelve studies comprising 2,118 patients met inclusion criteria. CT-FFR demonstrated higher sensitivity (82–92%) than DSE (68–80%) in most studies, while specificity was generally comparable. CT-FFR was advantageous in patients with multivessel disease and in cases with limited echocardiographic imaging. Variations in imaging protocols and endpoint definitions introduced some heterogeneity, limiting direct comparisons.

Conclusion:
Current evidence supports the superior diagnostic sensitivity of CT-FFR over DSE for detecting functionally significant CAD. CT-FFR’s capacity to simultaneously evaluate coronary anatomy and physiology reinforces its growing role as a preferred first-line non-invasive test. Standardized prospective studies are needed to confirm these findings.