title: Anatomic versus physiologic assessment of coronary artery disease. Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making.
abstract: Angiographic severity of coronary artery stenosis has historically been the primary guide to revascularization or medical management of coronary artery disease. However, physiologic severity defined by coronary pressure and/or flow has resurged into clinical prominence as a potential, fundamental change from anatomically to physiologically guided management. This review addresses clinical coronary physiology-pressure and flow-as clinical tools for treating patients. We clarify the basic concepts that hold true for whatever technology measures coronary physiology directly and reliably, here focusing on positron emission tomography and its interplay with intracoronary measurements.
authors: Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas. Electronic address: K.Lance.Gould@uth.tmc.edu.
authors: K Lance
authors: KL
authors: Gould
authors: Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas.
authors: Nils P
authors: NP
authors: Johnson
authors: Mid America Heart Institute, Cardiovascular Consultants PA, and the University of Missouri-Kansas City, Kansas City, Missouri.
authors: Timothy M
authors: TM
authors: Bateman
authors: Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors: Rob S
authors: RS
authors: Beanlands
authors: Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany.
authors: Frank M
authors: FM
authors: Bengel
authors: Ochsner Medical Center, New Orleans, Louisiana.
authors: Robert
authors: R
authors: Bober
authors: Vita-Salute University San Raffaele and San Raffaele Scientific Institute, Milan, Italy.
authors: Paolo G
authors: PG
authors: Camici
authors: Department of Molecular & Functional Imaging, Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Manuel D
authors: MD
authors: Cerqueira
authors: Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors: Benjamin J W
authors: BJW
authors: Chow
authors: Cardiovascular Imaging Program, Division of Cardiovascular Medicine, and Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Marcelo F
authors: MF
authors: Di Carli
authors: Cardiovascular Imaging Program, Division of Cardiovascular Medicine, and Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Sharmila
authors: S
authors: Dorbala
authors: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Henry
authors: H
authors: Gewirtz
authors: Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors: Robert J
authors: RJ
authors: Gropler
authors: Cardiac Imaging and Zurich Center for Integrative Human Physiology, University Hospital Zurich, Zurich, Switzerland.
authors: Philipp A
authors: PA
authors: Kaufmann
authors: Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
authors: Paul
authors: P
authors: Knaapen
authors: Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
authors: Juhani
authors: J
authors: Knuuti
authors: Heart Center of Niagara, Niagara Falls, New York.
authors: Michael E
authors: ME
authors: Merhige
authors: Gramercy Cardiac Diagnostic, New York, New York.
authors: K Peter
authors: KP
authors: Rentrop
authors: Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors: Terrence D
authors: TD
authors: Ruddy
authors: Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California.
authors: Heinrich R
authors: HR
authors: Schelbert
authors: Department of Specialties in Medicine, Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland.
authors: Thomas H
authors: TH
authors: Schindler
authors: Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, München, Germany.
authors: Markus
authors: M
authors: Schwaiger
authors: Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas.
authors: Stefano
authors: S
authors: Sdringola
authors: Cardiovascular Specialists of Frederick, Frederick, Maryland.
authors: John
authors: J
authors: Vitarello
authors: Division of Cardiovascular Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors: Kim A
authors: KA
authors: Williams
authors: Cardiovascular Associates of the Southeast, Birmingham, Alabama.
authors: Donald
authors: D
authors: Gordon
authors: Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors: Vasken
authors: V
authors: Dilsizian
authors: Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York.
authors: Jagat
authors: J
authors: Narula
mesh_terms: D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D003657:Decision Making; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D023421:Models, Animal; D008955:Models, Cardiovascular; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D049268:Positron-Emission Tomography; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: CAD; CFR; ECG; FFR; MI; PCI; PET; PET perfusion imaging; SPECT; coronary artery disease; coronary flow; coronary flow reserve; coronary physiology; electrocardiographic/electrocardiography; fractional flow reserve; ischemia; myocardial infarction; percutaneous intervention; positron emission tomography; revascularization; single-photon emission computed tomography