TY - JOUR
T1 - Reliability and Reproducibility of Absolute Myocardial Blood Flow
T2 - Does It Depend on the PET/CT Technology, the Vasodilator, and/or the Software?
AU - Gould, K. Lance
AU - Bui, Linh
AU - Kitkungvan, Danai
AU - Patel, Monica B.
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2021/3
Y1 - 2021/3
N2 - Purpose of Review: The COURAGE and ISCHEMIA trials showed no reduced mortality after revascularization compared to medical treatment. Is this lack of benefit due to revascularization having no benefit regardless of CAD severity or to suboptimal patient selection due to non-quantitative cardiac imaging? Recent Findings: Comprehensive, integrated, myocardial perfusion quantified by regional pixel distribution of coronary flow capacity (CFC) is the final common expression of objective CAD severity for which revascularization reduces mortality. Current lack of revascularization benefit derives from narrow thinking focused on measuring one isolated aspect of coronary characteristics, such as angiogram stenosis, its fractional flow reserve (FFR), anatomic FFR simulations, relative stress imaging, absolute stress ml/min/g or coronary flow reserve (CFR) alone, or even more narrowly on global CFR or fixed regions of interest in assumed coronary artery distributions, or in arbitrary 17 segments on bull’s-eye displays, rather than regional pixel distribution of perfusion metrics as they actually are in an individual. Summary: Comprehensive integration of all quantitative perfusion metrics per regional pixel into coronary flow capacity guides artery-specific interventions for reduced mortality in non-acute CAD but requires addressing the methodologic questions in the title.
AB - Purpose of Review: The COURAGE and ISCHEMIA trials showed no reduced mortality after revascularization compared to medical treatment. Is this lack of benefit due to revascularization having no benefit regardless of CAD severity or to suboptimal patient selection due to non-quantitative cardiac imaging? Recent Findings: Comprehensive, integrated, myocardial perfusion quantified by regional pixel distribution of coronary flow capacity (CFC) is the final common expression of objective CAD severity for which revascularization reduces mortality. Current lack of revascularization benefit derives from narrow thinking focused on measuring one isolated aspect of coronary characteristics, such as angiogram stenosis, its fractional flow reserve (FFR), anatomic FFR simulations, relative stress imaging, absolute stress ml/min/g or coronary flow reserve (CFR) alone, or even more narrowly on global CFR or fixed regions of interest in assumed coronary artery distributions, or in arbitrary 17 segments on bull’s-eye displays, rather than regional pixel distribution of perfusion metrics as they actually are in an individual. Summary: Comprehensive integration of all quantitative perfusion metrics per regional pixel into coronary flow capacity guides artery-specific interventions for reduced mortality in non-acute CAD but requires addressing the methodologic questions in the title.
KW - Cardiac positron emission tomography
KW - Coronary artery disease
KW - Coronary flow capacity
KW - Coronary flow reserve
KW - Myocardial perfusion
KW - Revascularization
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U2 - 10.1007/s11886-021-01449-8
DO - 10.1007/s11886-021-01449-8
M3 - Review article
C2 - 33483794
AN - SCOPUS:85099909954
SN - 1523-3782
VL - 23
JO - Current Cardiology Reports
JF - Current Cardiology Reports
IS - 3
M1 - 12
ER -