From Physiology of the Coronary Circulation to Myocardial Perfusion Imaging

Abstract The present paper reviews important recent publications concerning the application of principles of coronary physiology to quantitative PET myocardial perfusion imaging. Invasive measurements as well as coronary computed tomography angiography are also considered. The review focuses on physiological concepts relevant to the understanding of the effects of coronary atherosclerosis on myocardial blood flow (MBF) responses to stress. It also highlights the increasing shift from an anatomical paradigm of stenosis severity assessment to a physiological one, emphasizing the importance of absolute measurements of MBF. Key concepts and supporting literature reviewed in the present paper include quantitative PET measurements of absolute rest and stress MBF, the use of stress MBF alone for physiological assessment of stenosis functional severity, the utility of ratios such as fractional flow reserve (FFR) and coronary flow reserve (CFR) in assessing stenosis severity, and most importantly, the absolute level of MBF required to sustain vigorous physical exercise (9–10 metabolic equivalents (METs)) in healthy adults.
Source: Current Cardiovascular Imaging Reports - Category: Radiology Source Type: research