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.


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