ArticleCirculation2011
Improved cardiac risk assessment with noninvasive measures of coronary flow reserve.
Article in Circulation, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 418 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Comprehensive Treatment of Angina in Women With Microvascular Dysfunction - a Proof of Concept Study of the iPower Cohort
Ammonia N-13 Myocardial Blood Flow Absolute Quantification by Positron Emission Tomography in Patients With Known or Suspected Coronary Artery Disease (Ammonia MAP)
Impact of Coronary Artery Stenting on Quantitative Myocardial Blood Flow and Health Status
Prospective Evaluation of Chemotherapy-Induced Cardiotoxicity by Serial PET Myocardial Perfusion and Blood Flow Assessment - the PRECISION Trial
Who cites it
418 citing papers in PubMed, 5 syntheses or guidelines pooled it, 830 citations in OpenAlex.
- ESR Essentials: imaging in stable chest pain - practice recommendations by ESCR.European radiology · 2024Guideline
- The Role of Artificial Intelligence in Predicting Outcomes by Cardiovascular Magnetic Resonance: A Comprehensive Systematic Review.Medicina (Kaunas, Lithuania) · 2022Pooled it
- Advances in Myocardial Perfusion MR Imaging: Physiological Implications, the Importance of Quantitative Analysis, and Impact on Patient Care in Coronary Artery Disease.Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine · 2022Pooled it
- Prognostic value of coronary flow reserve in patients with suspected or known coronary artery disease referred to PET myocardial perfusion imaging: A meta-analysis.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Pooled it
- Update of the Brazilian Guideline on Nuclear Cardiology - 2020.Arquivos brasileiros de cardiologia · 2020Guideline
- Interplay Between Systemic Inflammation, Myocardial Injury, and Coronary Microvascular Dysfunction in Rheumatoid Arthritis: Results From the LiiRA Study.Journal of the American Heart Association · 2024Trial
- Coronary Microvascular Dysfunction Is Present Among Well-Treated Asymptomatic Persons With HIV and Similar to Those With Diabetes.Open forum infectious diseases · 2024Trial
- Randomized Placebo-Controlled Trial to Evaluate Effects of Eplerenone on Myocardial Perfusion and Function Among Persons With Human Immunodeficiency Virus (HIV)-Results From the MIRACLE HIV Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- Improved myocardial blood flow estimation with residual activity correction and motion correction inEuropean journal of nuclear medicine and molecular imaging · 2022Trial
- Autologous CD34+ Stem Cell Therapy Increases Coronary Flow Reserve and Reduces Angina in Patients With Coronary Microvascular Dysfunction.Circulation. Cardiovascular interventions · 2022Trial
- Added value of myocardial blood flow usingJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Trial
- Effects of cardiac rehabilitation with and without meditation on myocardial blood flow using quantitative positron emission tomography: A pilot study.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Trial
- Reducing motion-correction-induced variability inJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Trial
- The Prognostic Significance of Quantitative Myocardial Perfusion: An Artificial Intelligence-Based Approach Using Perfusion Mapping.Circulation · 2020Trial
- Molecular Mechanisms Underlying the Comorbidity of Type 2 Diabetes Mellitus and Coronary Artery Disease: from Insulin Resistance and Inflammation to Endothelial Dysfunction and Therapeutic Implications.Cardiovascular drugs and therapy · 2026Review
- Reduced ¹³N-Ammonia PET Myocardial Flow Reserve and Heart-Failure-Related Risk Independent of Relative Ischemia in Chronic Coronary Syndrome.European journal of nuclear medicine and molecular imaging · 2026Article
- Exploratory Evaluation of Quantitative Rubidium-82 PET Myocardial Perfusion Parameters: Absolute Blood Flow, Flow Reserve, and Left Ventricular Function in an Arabian Gulf Cohort.Journal of clinical medicine · 2026Article
- Coronary Microvascular Dysfunction: Pathophysiology, Clinical Phenotypes, and Mechanism-Guided Diagnostic Strategies.Journal of cardiovascular development and disease · 2026Review
- Establishing normal myocardial blood flow and myocardial flow reserve values: a rubidium-82 positron emission tomography study.European journal of nuclear medicine and molecular imaging · 2026Article
- Blunted heart rate response during dipyridamole stress SPECT is associated with cardiovascular outcomes in an all-comers cohort.BMC cardiovascular disorders · 2026Article
358 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 1 institution in 1 country.
Funding
Abstract
backgroundImpaired vasodilator function is an early manifestation of coronary artery disease and may precede angiographic stenosis. It is unknown whether noninvasive assessment of coronary vasodilator function in patients with suspected or known coronary artery disease carries incremental prognostic significance. METHODS AND
resultsA total of 2783 consecutive patients referred for rest/stress positron emission tomography were followed up for a median of 1.4 years (interquartile range, 0.7-3.2 years). The extent and severity of perfusion abnormalities were quantified by visual evaluation of myocardial perfusion images. Rest and stress myocardial blood flows were calculated with factor analysis and a 2-compartment kinetic model and were used to compute coronary flow reserve (coronary flow reserve equals stress divided by rest myocardial blood flow). The primary end point was cardiac death. Overall 3-year cardiac mortality was 8.0%. The lowest tertile of coronary flow reserve (<1.5) was associated with a 5.6-fold increase in the risk of cardiac death (95% confidence interval, 2.5-12.4; P<0.0001) compared with the highest tertile. Incorporation of coronary flow reserve into cardiac death risk assessment models resulted in an increase in the c index from 0.82 (95% confidence interval, 0.78-0.86) to 0.84 (95% confidence interval, 0.80-0.87; P=0.02) and in a net reclassification improvement of 0.098 (95% confidence interval, 0.025-0.180). Addition of coronary flow reserve resulted in correct reclassification of 34.8% of intermediate-risk patients (net reclassification improvement=0.487; 95% confidence interval, 0.262-0.731). Corresponding improvements in risk assessment for mortality from any cause were also demonstrated.
conclusionNoninvasive quantitative assessment of coronary vasodilator function with positron emission tomography is a powerful, independent predictor of cardiac mortality in patients with known or suspected coronary artery disease and provides meaningful incremental risk stratification over clinical and gated myocardial perfusion imaging variables.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.