Related Experiment Video
Updated: Nov 20, 2025
High-Resolution Cardiac Positron Emission Tomography/Computed Tomography for Small Animals
Published on: December 16, 2022
Reliability and Reproducibility of Absolute Myocardial Blood Flow: Does It Depend on the PET/CT Technology, the
K Lance Gould1,2, Linh Bui3, Danai Kitkungvan3
1Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA. k.lance.gould@uth.tmc.edu.
Insights
Revascularization may reduce mortality in coronary artery disease (CAD) when guided by comprehensive coronary flow capacity (CFC) imaging. Current methods fail to identify patients who benefit, leading to suboptimal outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- The COURAGE and ISCHEMIA trials indicated no mortality benefit from revascularization versus medical management in coronary artery disease (CAD).
- This lack of benefit may stem from inadequate patient selection due to non-quantitative cardiac imaging methods.
- Current imaging focuses on isolated parameters, failing to capture the integrated severity of CAD.
Purpose of the Study:
- To investigate if comprehensive, quantitative myocardial perfusion imaging can identify CAD patients who benefit from revascularization.
- To explore the role of coronary flow capacity (CFC) in guiding revascularization decisions for improved mortality outcomes.
- To address methodologic questions regarding optimal patient selection for revascularization in non-acute CAD.
Main Methods:
- Utilizing comprehensive, integrated myocardial perfusion quantification through regional pixel distribution of coronary flow capacity (CFC).
- Moving beyond single-metric assessments like stenosis, FFR, or global CFR.
- Focusing on the regional pixel distribution of perfusion metrics for individual patient assessment.
Main Results:
- Comprehensive, integrated CFC is proposed as the objective measure of CAD severity that predicts mortality benefit from revascularization.
- Current revascularization strategies lack benefit due to narrow, non-quantitative imaging assessments.
- Artery-specific interventions guided by integrated CFC can reduce mortality in non-acute CAD.
Conclusions:
- Revascularization benefit in CAD is contingent on objective, comprehensive assessment of myocardial perfusion via CFC.
- Improved patient selection using quantitative perfusion imaging is crucial for realizing revascularization benefits.
- Further research is needed to address methodologic challenges in implementing CFC for guiding revascularization.
Purpose Of Review:
The COURAGE and ISCHEMIA trials showed no reduced mortality after revascularization compared to medical treatment. Is this lack of benefit due to revascularization having no benefit regardless of CAD severity or to suboptimal patient selection due to non-quantitative cardiac imaging?
Recent Findings:
Comprehensive, integrated, myocardial perfusion quantified by regional pixel distribution of coronary flow capacity (CFC) is the final common expression of objective CAD severity for which revascularization reduces mortality. Current lack of revascularization benefit derives from narrow thinking focused on measuring one isolated aspect of coronary characteristics, such as angiogram stenosis, its fractional flow reserve (FFR), anatomic FFR simulations, relative stress imaging, absolute stress ml/min/g or coronary flow reserve (CFR) alone, or even more narrowly on global CFR or fixed regions of interest in assumed coronary artery distributions, or in arbitrary 17 segments on bull's-eye displays, rather than regional pixel distribution of perfusion metrics as they actually are in an individual. Comprehensive integration of all quantitative perfusion metrics per regional pixel into coronary flow capacity guides artery-specific interventions for reduced mortality in non-acute CAD but requires addressing the methodologic questions in the title.
More Related Videos
08:13In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
06:39Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice
Published on: April 13, 2015
