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Updated: May 4, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography
Masanao Naya1, Venkatesh L Murthy, Viviany R Taqueti
1NonInvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
Insights
A normal coronary flow reserve (CFR) effectively excludes high-risk coronary artery disease (CAD) on angiography. This finding is crucial for improving diagnostic accuracy and patient management in cardiology.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Nuclear Cardiology
Background:
- Myocardial perfusion imaging has limitations in detecting high-risk coronary artery disease (CAD).
- Coronary flow reserve (CFR) is a measure of blood flow in the coronary arteries.
- Assessing CFR may improve the diagnosis of significant obstructive CAD.
Purpose of the Study:
- To evaluate the utility of a normal coronary flow reserve (CFR) in excluding high-risk coronary artery disease (CAD) detected by invasive coronary angiography.
- To determine if CFR provides incremental diagnostic value beyond existing risk scores and imaging parameters.
Main Methods:
- 290 patients undergoing Rubidium-82 PET and invasive coronary angiography were studied.
- High-risk CAD was defined as 2-vessel disease (≥70% stenosis including proximal LAD), 3-vessel disease, or left main CAD (≥50% stenosis).
- Exclusion criteria included prior MI, elevated troponin, prior CABG, LVEF <40%, or severe valvular disease.
Main Results:
- 19% of patients had high-risk CAD.
- A binary CFR ≤1.93 provided incremental diagnostic information for high-risk CAD (P=0.0009).
- In patients with normal/mild perfusion defects (n=136), a preserved CFR (>1.93) excluded high-risk CAD with 86% sensitivity and 97% negative predictive value.
Conclusions:
- A normal coronary flow reserve (CFR) demonstrates a high negative predictive value for excluding high-risk coronary artery disease (CAD).
- While an abnormal CFR suggests obstructive CAD, it cannot differentiate epicardial stenosis from non-obstructive atherosclerosis or microvascular dysfunction.
Unlabelled:
Myocardial perfusion imaging has limited sensitivity for the detection of high-risk coronary artery disease (CAD). We tested the hypothesis that a normal coronary flow reserve (CFR) would be helpful for excluding the presence of high-risk CAD on angiography.
Methods:
We studied 290 consecutive patients undergoing (82)Rb PET within 180 d of invasive coronary angiography. High-risk CAD on angiography was defined as 2-vessel disease (≥ 70% stenosis), including the proximal left anterior descending artery; 3-vessel disease; or left main CAD (≥ 50% stenosis). Patients with prior Q wave myocardial infarction, elevated troponin levels between studies, prior coronary artery bypass grafting, a left ventricular ejection fraction of less than 40%, or severe valvular heart disease were excluded.
Results:
Fifty-five patients (19%) had high-risk CAD on angiography. As expected, the trade-off between the sensitivity and the specificity of the CFR for identifying high-risk CAD varied substantially depending on the cutoff selected. In multivariable analysis, a binary CFR of less than or equal to 1.93 provided incremental diagnostic information for the identification of high-risk CAD beyond the model with the Duke clinical risk score (>25%), percentage of left ventricular ischemia (>10%), transient ischemic dilation index (>1.07), and change in the left ventricular ejection fraction during stress (<2) (P = 0.0009). In patients with normal or slightly to moderately abnormal results on perfusion scans (<10% of left ventricular mass) during stress (n = 136), a preserved CFR (>1.93) excluded high-risk CAD with a high sensitivity (86%) and a high negative predictive value (97%).
Conclusion:
A normal CFR has a high negative predictive value for excluding high-risk CAD on angiography. Although an abnormal CFR increases the probability of significant obstructive CAD, it cannot reliably distinguish significant epicardial stenosis from nonobstructive, diffuse atherosclerosis or microvascular dysfunction.
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