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

K Lance Gould; Nils P Johnson; Timothy M Bateman; Rob S Beanlands; Frank M Bengel; Robert Bober; Paolo G Camici; Manuel D Cerqueira; Benjamin J W Chow; Marcelo F Di Carli; Sharmila Dorbala; Henry Gewirtz; Robert J Gropler; Philipp A Kaufmann; Paul Knaapen; Juhani Knuuti; Michael E Merhige; K Peter Rentrop; Terrence D Ruddy; Heinrich R Schelbert; Thomas H Schindler; Markus Schwaiger; Stefano Sdringola; John Vitarello; Kim A Williams Sr; Donald Gordon; Vasken Dilsizian; Jagat Narula

doi:10.1016/j.jacc.2013.07.076

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

J Am Coll Cardiol. 2013 Oct 29;62(18):1639-1653. doi: 10.1016/j.jacc.2013.07.076. Epub 2013 Aug 28.

Authors

K Lance Gould¹, Nils P Johnson², Timothy M Bateman³, Rob S Beanlands⁴, Frank M Bengel⁵, Robert Bober⁶, Paolo G Camici⁷, Manuel D Cerqueira⁸, Benjamin J W Chow⁴, Marcelo F Di Carli⁹, Sharmila Dorbala⁹, Henry Gewirtz¹⁰, Robert J Gropler¹¹, Philipp A Kaufmann¹², Paul Knaapen¹³, Juhani Knuuti¹⁴, Michael E Merhige¹⁵, K Peter Rentrop¹⁶, Terrence D Ruddy⁴, Heinrich R Schelbert¹⁷, Thomas H Schindler¹⁸, Markus Schwaiger¹⁹, Stefano Sdringola², John Vitarello²⁰, Kim A Williams Sr²¹, Donald Gordon²², Vasken Dilsizian²³, Jagat Narula²⁴

Affiliations

¹ 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: [email protected].
² Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas.
³ Mid America Heart Institute, Cardiovascular Consultants PA, and the University of Missouri-Kansas City, Kansas City, Missouri.
⁴ Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
⁵ Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany.
⁶ Ochsner Medical Center, New Orleans, Louisiana.
⁷ Vita-Salute University San Raffaele and San Raffaele Scientific Institute, Milan, Italy.
⁸ Department of Molecular & Functional Imaging, Cleveland Clinic Foundation, Cleveland, Ohio.
⁹ Cardiovascular Imaging Program, Division of Cardiovascular Medicine, and Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
¹⁰ Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
¹¹ Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
¹² Cardiac Imaging and Zurich Center for Integrative Human Physiology, University Hospital Zurich, Zurich, Switzerland.
¹³ Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
¹⁴ Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
¹⁵ Heart Center of Niagara, Niagara Falls, New York.
¹⁶ Gramercy Cardiac Diagnostic, New York, New York.
¹⁷ Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California.
¹⁸ Department of Specialties in Medicine, Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland.
¹⁹ Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, München, Germany.
²⁰ Cardiovascular Specialists of Frederick, Frederick, Maryland.
²¹ Division of Cardiovascular Medicine, Wayne State University School of Medicine, Detroit, Michigan.
²² Cardiovascular Associates of the Southeast, Birmingham, Alabama.
²³ Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
²⁴ Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York.

PMID: 23954338
DOI: 10.1016/j.jacc.2013.07.076

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.

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.

Publication types

Review

MeSH terms

Animals
Blood Flow Velocity / physiology
Blood Pressure / physiology
Clinical Trials as Topic
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / physiopathology*
Coronary Stenosis / diagnostic imaging
Coronary Stenosis / physiopathology
Decision Making
Fractional Flow Reserve, Myocardial / physiology*
Humans
Models, Animal
Models, Cardiovascular
Myocardial Perfusion Imaging*
Myocardial Revascularization
Positron-Emission Tomography
Prevalence
Risk Factors
Severity of Illness Index