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Reasons and implications of agreements and disagreements between coronary flow reserve, fractional flow reserve, and myocardial perfusion imaging

  • Review Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

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.

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Abbreviations

CAD:

Coronary artery disease

SPECT:

Single photon emission computerized tomography

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

FFR:

Fractional flow reserve

CFR:

Coronary flow reserve

MBF:

Myocardial blood flow

PCI:

Percutaneous coronary intervention

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Disclosure

Manish Motwani is supported by the Dowager Countess Eleanor Peel Trust (Rothwell-Jackson Travelling Fellowship [UK]) and the Dickinson Trust Scholarship (UK). Mahsaw Motlagh and Anuj Gupta have no disclosures. Cedars-Sinai Medical Center receives royalties for the quantitative assessment of function, perfusion, and flow, a portion of which is distributed to Daniel S Berman and Piotr J. Slomka.

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  1. Departments of Imaging and Medicine and the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Manish Motwani PhD, Mahsaw Motlagh BA, Daniel S. Berman MD & Piotr J. Slomka PhD

  2. Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Anuj Gupta MD

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  1. Manish Motwani PhD
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Motwani, M., Motlagh, M., Gupta, A. et al. Reasons and implications of agreements and disagreements between coronary flow reserve, fractional flow reserve, and myocardial perfusion imaging. J. Nucl. Cardiol. 25, 104–119 (2018). https://doi.org/10.1007/s12350-015-0375-1

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