Author + information
- Received May 20, 2013
- Revision received July 1, 2013
- Accepted July 24, 2013
- Published online October 29, 2013.
- K. Lance Gould, MD1,∗ (, )
- Nils P. Johnson, MD, MS1,
- Timothy M. Bateman, MD2,
- Rob S. Beanlands, MD3,
- Frank M. Bengel, MD4,
- Robert Bober, MD5,
- Paolo G. Camici, MD6,
- Manuel D. Cerqueira, MD7,
- Benjamin J.W. Chow, MD3,
- Marcelo F. Di Carli, MD8,
- Sharmila Dorbala, MD, MPH8,
- Henry Gewirtz, MD9,
- Robert J. Gropler, MD10,
- Philipp A. Kaufmann, MD11,
- Paul Knaapen, MD, PhD12,
- Juhani Knuuti, MD, PhD13,
- Michael E. Merhige, MD14,
- K. Peter Rentrop, MD15,
- Terrence D. Ruddy, MD3,
- Heinrich R. Schelbert, MD, PhD16,
- Thomas H. Schindler, MD17,
- Markus Schwaiger, MD18,
- Stefano Sdringola, MD1,
- John Vitarello, MD19,
- Kim A. Williams Sr, MD20,
- Donald Gordon, MD21,
- Vasken Dilsizian, MD22 and
- Jagat Narula, MD, PhD23
- 1Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas
- 2Mid America Heart Institute, Cardiovascular Consultants PA, and the University of Missouri–Kansas City, Kansas City, Missouri
- 3Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- 4Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany
- 5Ochsner Medical Center, New Orleans, Louisiana
- 6Vita-Salute University San Raffaele and San Raffaele Scientific Institute, Milan, Italy
- 7Department of Molecular & Functional Imaging, Cleveland Clinic Foundation, Cleveland, Ohio
- 8Cardiovascular Imaging Program, Division of Cardiovascular Medicine, and Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- 9Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- 10Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- 11Cardiac Imaging and Zurich Center for Integrative Human Physiology, University Hospital Zurich, Zurich, Switzerland
- 12Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
- 13Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- 14Heart Center of Niagara, Niagara Falls, New York
- 15Gramercy Cardiac Diagnostic, New York, New York
- 16Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California
- 17Department of Specialties in Medicine, Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland
- 18Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, München, Germany
- 19Cardiovascular Specialists of Frederick, Frederick, Maryland
- 20Division of Cardiovascular Medicine, Wayne State University School of Medicine, Detroit, Michigan
- 21Cardiovascular Associates of the Southeast, Birmingham, Alabama
- 22Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- 23Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. K. Lance Gould, Martin Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston, 6431 Fannin Street, Room MSB 4.256, Houston, Texas 77030.
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.
Dr. Gould received internal funding from the Weatherhead PET Center for Preventing and Reversing Atherosclerosis; the 510(k) applicant for cfrQuant approved by the FDA; and he has arranged that all his royalties permanently go to a University of Texas scholarship fund. UT has a commercial nonexclusive agreement with Positron Corporation to distribute and market cfrQuant in exchange for royalties; however, Dr. Gould retains the ability to distribute cost-free versions to selected collaborators for research. Additionally, Dr. Gould has signed a nonfinancial, mutual nondisclosure agreement with Volcano Corporation (maker of FFR pressure wires) to discuss coronary physiology projects. Dr. Johnson has received internal funding from the Weatherhead PET Center for Preventing and Reversing Atherosclerosis; and has signed a nonfinancial, mutual nondisclosure agreement with Volcano Corporation (maker of FFR pressure wires) to discuss coronary physiology projects. Dr. Bateman has received research grants from Bracco, Philips, GE, SpectrumDynamics, and Astellas; is on advisory boards of Astellas, GE, SpectrumDynamics; receives royalties from ImagenPro/MD/Q; and has ownership of CVIT. Dr. Beanlands is a career investigator supported by the Heart and Stroke Foundation of Ontario; is a tier 1 University of Ottawa Chair in Cardiovascular Research; consults with Jubilant DRAXImage and Lantheus; has received grant funding from a government/industry program (partners: GE Healthcare, Nordion, Lantheus Medical Imaging, DRAXImage); consults for Lantheus Medical Imaging and has received grant funding from Genentech; and has received more than $10,000 for research grants. Dr. Bengel has received research grants from GE Healthcare, Bracco Diagnostics, and Lantheus Medical Imaging; and speaker honoraria from Siemens Medical Solutions. Dr. Cerqueira consults for Astellas Pharma US, Cardinal Health, CoreLab Partners, GE Healthcare, and Lantheus Medical Imaging; is on the speakers bureau for Astellas Pharma US and GE Healthcare; and has received research funding from Perceptive Informatics. Dr. Chow is a consultant for GE Healthcare and TeraRecon. Dr. Di Carli receives research grant support from Toshiba Medical Systems and Gilead. Dr. Dorbala has received research grants from Astellas Pharma and stock holdings from General Electric. Dr. Gewirtz has received financial support from the Wild Family Foundation and FluoroPharma, Inc. Dr. Gropler consults for Molecular Insight Pharmaceuticals and Lantheus Medical Imaging; and has received NIH research funding. Dr. Kaufmann is supported by a fund of the Swiss National Science Foundation and the Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland. University Hospital Zurich holds a research grant with GE Healthcare. Dr. Knuuti is supported by Academy of Finland Centre of Excellence in Molecular Imaging in Cardiovascular and Metabolic Research, Helsinki, Finland; has received grant support from Gilead Inc.; and is a consultant to Lantheus Inc. Dr. Merhige is the medical director of and owns stock in Positron Corporation. Dr. Ruddy has received grant support and honoraria from GE Healthcare and MDS Nordion. Dr. Schwaiger has received research grants from Siemens and Lantheus. Dr. Sdringola has received internal funding from the Weatherhead PET Center for Preventing and Reversing Atherosclerosis. Dr. Williams consults and speaks for Astellas Healthcare, Inc. Dr. Gordon is a consultant for Bracco Diagnostics. Dr. Dilsizian is a consultant for and has received research funding from Molecular Insight Pharmaceuticals. Dr. Narula has received research grants and honoraria from GE Healthcare and Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. William E. Boden, MD, acted as Guest Editor for this article.
- Received May 20, 2013.
- Revision received July 1, 2013.
- Accepted July 24, 2013.
- 2013 American College of Cardiology Foundation
- Prevalence, Severity, and Risk
- Limitation of Current Cardiovascular Paradigm
- Why Physiologic Severity of Coronary Artery Disease?
- Physiologic Versus Anatomic Severity
- Are FFR Versus CFR Competitive or Complimentary?
- Bridging Invasive FFR and Quantitative PET Perfusion Imaging
- Clinical Implications of Adequate CFR With Low FFR?
- What About FAME?
- Predicting Physiology From Anatomy
- Absolute Myocardial Perfusion by PET
- Ranges of Coronary Flow Capacity and the Ischemic Threshold
- Relative Uptake PET Perfusion Images
- Clinical Reports Including Quantitative Perfusion
- Additional Uses of PET Perfusion Imaging