Is discordance of coronary flow reserve and fractional flow reserve due to methodology or clinically relevant coronary pathophysiology?

JACC. Cardiovascular Imaging
Nils P JohnsonK Lance Gould

Abstract

The purpose of this study was to determine whether observed discordance between coronary flow reserve (CFR) and fractional flow reserve (FFR) is due to methodology or reflects basic coronary pathophysiology. Despite the clinical importance of coronary physiological assessment, relationships between its 2 most common tools, CFR and FFR, remain poorly defined. The worst CFR and stress relative uptake were recorded from 1,500 sequential cardiac positron emission tomography cases from our center. From the literature, we assembled all combined, invasive CFR-FFR measurements, including a subset before and after angioplasty. Both datasets were compared with a fluid dynamic model of the coronary circulation predicting relationships between CFR and FFR for variable diffuse and focal narrowing. A modest but significant linear relationship exists between CFR and FFR both invasively (r = 0.34, p < 0.001) and using positron emission tomography (r = 0.36, p < 0.001). Most clinical patients undergoing CFR or FFR measurements have diffusely reduced CFR consistent with diffuse atherosclerosis or small-vessel disease. The theoretical model predicts linear relationships between CFR and FFR for progressive stenosis with slopes dependent on diffuse...Continue Reading

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Citations

Oct 23, 2013·European Journal of Nuclear Medicine and Molecular Imaging·Paul Knaapen
Jul 24, 2013·Journal of Cardiovascular Translational Research·Li-Ming GanRegina Fritsche-Danielson
Oct 16, 2012·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Nils P Johnson, K Lance Gould
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Jun 21, 2012·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Venkatesh L Murthy, Marcelo F Di Carli
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Mar 12, 2016·Journal of the American College of Cardiology·Joo Myung LeeBon-Kwon Koo
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Sep 26, 2015·JACC. Cardiovascular Interventions·Julien AdjedjBernard De Bruyne
Mar 19, 2014·JACC. Cardiovascular Imaging·Ines ValentaThomas H Schindler
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