Except, you're not engaging in preventative care. Preventative care would be to set a goal over the next 6 months of doubling your weekly running mileage, or some other physical activity. I know you mentioned that you eat well, but in 30 years of medical practice, I can say that "I eat well," comes out of virtually every patient's mouth. Which seems disconnected from the reality I see when I go to Costco or Safeway and see what the majority of folks are cramming into their shopping carts.
As far as tests, things like cholesterol, A1c/blood glucose, colon/prostate/breast cancer screening. Those are preventative tests. So preventative care is counseling on lifestyle and a limited number of tests. That's it.
An FFR is not preventative care. It's a specialized test that is only useful in certain scenarios. The problem is that, unfortunately, you don't have a good handle on what these tests tell us and don't tell us.
What do we know? We know you don't have symptomatic cardiac disease and you run regularly. So, your pretest probability of having a significant blockage, although not zero, is low. We know your coronary CT scan was zero. So your post test probability is now markedly lower. We know your CTA was normal, which now makes your chance of significant obstructive CAD vanishingly low.
To get into a little more detail, typically an FFR is done where there is a question about the severity of blockage shown on a CTA, as excess calcium often interferes with the ability of a CTA to accurately assess that blockage. But we know you don't have any calcium, since your calcium score was zero!!! So your CTA, even without FFR, is likely highly accurate in confirming you don't have any blockages. FFR would likely offer no meaningful post test reduction in your probability of significant cardiac disease.
None of this should be construed as medical advice specific to your situation. You should ask your cardiologist, "how good were the images on the CTA," and , "in your opinion, is there any value to an FFR?" Dang, that's why you pay your cardiologist 500k/year. To answer those questions. (Assuming he doesn't have a financial interest in the imaging center, er, that' a whole different bag of worms...)
The aircraft analogy is as follows.
Your engine is running fine, but, for "peace of mind, you"
-Check the compression, and it's normal on all cylinders.
-You have a boroscope exam, and it's totally normal.
-But, you hear about a higher resolution, "4k HDR" boroscope exam that some mechanic on the other side of the country is offering.
So for peace of mind, you fly out to the other coast and have this done.
And, you sure wouldn't mind if someone else would pay for it
