title: Quantitative Coronary Physiology for Clinical Management: the Imaging Standard.
abstract: Pressure derived FFR and coronary flow capacity by PET define a physiologic severity-risk-benefit continuum wherein probability of benefit from revascularization over risk of the procedure and risk of residual global diffuse disease guides personalized, informed, evidenced based, interventional decisions. For the many variations in PET or MRI protocols for quantifying myocardial perfusion to define physiologic severity, the simple standard performance test combining measurement accuracy and clinical coronary pathophysiology to assure correct clinical decisions is the capacity to measure (i) rest perfusion of 0.2 cm(3)/min/gm in transmural scar in at least five patients to test low perfusion accuracy (ii) regional and global CFR of 4.0 or stress perfusion of 2.9 cm(3)/min/gm on two sequential rest-stress PET perfusion studies in the same subject with ±15 % variability for at least 15 young healthy volunteers with no risk factors, no smoking, no obesity, and no measureable blood caffeine levels.
authors.affiliation: Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, TX, USA. k.lance.gould@uth.tmc.edu.|Weatherhead PET Center, University of Texas Medical School at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX, 77030, USA. k.lance.gould@uth.tmc.edu.
authors.forename: K Lance
authors.initials: KL
authors.lastname: Gould
authors.affiliation: Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, TX, USA.
authors.forename: Nils P
authors.initials: NP
authors.lastname: Johnson
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003326:Coronary Circulation; D006801:Humans; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D018579:Patient Selection; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic; D012307:Risk Factors
keywords: Clinical coronary physiology; Physiologic severity of CAD; Quantitative imaging standard; Quantitative myocardial perfusion