caa a22 4500 465735886 CHVBK 20180323111754.0 cr unu---uuuuu 170327e19900201xx s 000 0 eng 10.1007/BF02576930 doi (NATIONALLICENCE)springer-10.1007/BF02576930 Gould K. Division of Cardiology, University of Texas Health Science Center at Houston, Houston, Texas, USA aut Detecting and assessing severity of coronary artery disease in humans [Elektronische Daten] [K. Gould] Quantitation of stenosis severity has become an essential part of cardiac diagnosis and therapy, not only in research but also in clinical practice. Since our introduction of the concept 15 years ago, arterial coronary flow reserve for assessing effects of coronary narrowing has evolved into two independent but complementary measurements: coronary flow reserve and stenosis flow reserve. Coronary artery flow reserve and/or myocardial perfusion reserve takes into account not only stenosis geometry but also collateral function and physiologic conditions of perfusion pressure, vasomotor tone, coronary venous pressure, and myocardial vascular bed size. Coronary artery flow reserve is measured invasively by flowmeter or by Doppler catheter. Its noninvasive equivalent is myocardial perfusion reserve, assessed by myocardial perfusion imaging with positron emission tomography before and after intravenous dipyridamole with hand grip stress. Both have been experimentally and clinically validated for identifying and/or quantifying severity of coronary artery disease. By either invasive or noninvasive methods, coronary artery or myocardial perfusion reserve may be subcategorized as either absolute flow or perfusion reserve (max flow/resting flow) and/or relative flow or perfusion reserve (max flow through stenotic artery/max flow through normal artery). Absolute flow reserve depends not only on stenosis severity but also on unrelated physiologic parameters such as aortic pressure and the vasodilatory state of the distal coronary vascular bed; in contrast, relative flow reserve is independent of these physiologic variables and reflects stenosis severity alone. Stenosis flow reserve is invasively determined by automated, quantitative coronary arteriography accounting for all stenosis dimensions and is independent of ambient physiologic conditions such as pressure, vasomotor tone, or other variables affecting the distal coronary vascular bed. It has also been validated experimentally, tested clinically, and is applicable to cine x-ray film-based systems or to on-line digital angiographic cath lab facilities for quantifying effects of therapeutic interventions. Both functional and anatomic measurements are necessary to completely define stenosis severity. Of noninvasive functional approaches for assessing stenosis severity, cardiac positron emission tomography (PET) is the optimum for assessing relative and absolute myocardial perfusion reserve. Of the invasive anatomic approaches, quantitative coronary arteriography is the optimum for determining stenosis flow reserve from all stenosis dimensions under standard conditions. Springer-Verlag New York Inc., 1990 Coronary stenosis nationallicence Positron emission tomography nationallicence Quantitative coronary arteriography nationallicence CardioVascular and Interventional Radiology Springer-Verlag 13/1(1990-02-01), 5-13 0174-1551 13:1<5 1990 13 270 https://doi.org/10.1007/BF02576930 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF02576930 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Gould K. Division of Cardiology, University of Texas Health Science Center at Houston, Houston, Texas, USA aut NATIONALLICENCE 773 0- CardioVascular and Interventional Radiology Springer-Verlag 13/1(1990-02-01), 5-13 0174-1551 13:1<5 1990 13 270 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer