Physiologic Severity of Diffuse Coronary Artery Disease

PET 18F-flurpridaz quantitative measurements of myocardial blood flow: Added value for diagnosis of coronary artery disease? Of course!

“…Contrariwise, with stress MBF at least moderately reduced, as the authors note, consistent with ''2 or 3 VD'', one commonly observes associated distal diffuse small vessel and true microvascular disease. 10,14 Parsing the loci of various resistance to flow is difficult in this setting. Invasive measurements of coronary flow (thermodilution) or flow velocity (doppler ultrasound) and pressures (proximal, distal, occlusive, and pull back) are required to help parse the components.…”

Patient Selection for Elective Revascularization to Reduce Myocardial Infarction and Mortality

“…[17][18][19] Because significant stenosis is usually associated with diffuse disease, the residual atherosclerosis may contravene the potential benefit of PCI as also evidenced by significant risk identified by the FFR measured after PCI. 12 For PCI to reduce MI or mortality, a stenosis has to be severe enough to pose a greater risk than associated diffuse disease plus risk of the revascularization procedure, as seen by the increased hazard ratio of 9.01 (95% confidence interval, 1.13-72.0) for death or MI compared with medical therapy within 7 days of PCI in FAME 2.…”

Exercise PET: More insight or more complex?

“…4,5,[10][11][12][13] Quantitative PET for CFR shows a high risk of MACE for global CFR of 1.5 or less indicating severe diffuse CAD 10 that may be moderated by coronary bypass surgery, 11 whereas revascularization for less severe disease provided no benefit. Thus, quantitative severity of focal and diffuse CAD is necessary to guide management and revascularization for reduced hard endpoints, not just diagnosis and prognosis.…”

“…4,5,[10][11][12][13] Since significant stenosis is usually associated with diffuse disease, the residual diffuse disease may contravene the potential benefit by PCI of stenosis, as also evidenced by a significant risk of residual FFR after successful PCI. 9 For PCI to reduce MI or mortality, a stenosis has to be severe enough to pose a greater cumulative risk than that from residual diffuse disease plus the revascularization procedure itself.…”