title: Reasons and implications of agreements and disagreements between coronary flow reserve, fractional flow reserve, and myocardial perfusion imaging.
abstract: Information on coronary physiology and myocardial blood flow (MBF) in patients with suspected angina is increasingly important to inform treatment decisions. A number of different techniques including myocardial perfusion imaging (MPI), noninvasive estimation of MBF, and coronary flow reserve (CFR), as well as invasive methods for CFR and fractional flow reserve (FFR) are now readily available. However, despite their incorporation into contemporary guidelines, these techniques are still poorly understood and their interpretation to guide revascularization decisions is often inconsistent. In particular, these inconsistencies arise when there are discrepancies between the various techniques. The purpose of this article is therefore to review the basic principles, techniques, and clinical value of MPI, FFR, and CFR-with particular focus on interpreting their agreements and disagreements.
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Manish
authors.initials: M
authors.lastname: Motwani
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Mahsaw
authors.initials: M
authors.lastname: Motlagh
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Anuj
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. slomkap@cshs.org.
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Slomka
mesh_terms: D002309:Cardiology / Q000592:standards; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D055414:Myocardial Perfusion Imaging; D062645:Percutaneous Coronary Intervention; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic; D015899:Tomography, Emission-Computed, Single-Photon