Does Coronary Flow Trump Coronary Anatomy?
K. Lance Gould, MD*
Weatherhead P.E.T. Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas
* Reprint requests and correspondence: Dr. K. Lance Gould, The Weatherhead P.E.T. Center, University of Texas Medical School, 6431 Fannin Street, Room 4.256MSB, Houston, Texas 77030 (Email: k.lance.gould{at}uth.tmc.edu).
Coronary function versus anatomy, flow versus stenosis: which optimizes coronary artery disease (CAD) management? In patients, coronary flow is poorly related to stenosis severity, and revascularization fails to improve mortality over medical treatment in randomized trials. Yet percutaneous intervention (PCI) guided by fractional flow reserve reduces coronary events more than PCI guided by arteriographic stenosis. These paradoxes are explained by the poor relation between coronary flow reserve (CFR) and stenosis severity due to diffuse CAD, with surprising clinical implications. Should the concept of anatomically "critical" coronary stenosis be replaced by the concept of "critical" CFR reduction for managing CAD?
Key Words: quantitative myocardial perfusion • quantitative cardiac PET • coronary flow • coronary stenosis • CAD
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CFR = coronary flow reserve | | CT = computed tomography | | FFR = fractional flow reserve | | HDL = high-density lipoprotein | | IVUS = intravascular ultrasound | | LAD = left anterior descending coronary artery | | LCx = left circumflex coronary artery | | PCI = percutaneous coronary intervention | | PET = positron emission tomography | | SPECT = single-photon emission computed tomography |
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