ArticleJACC. Cardiovascular imaging2012
Is discordance of coronary flow reserve and fractional flow reserve due to methodology or clinically relevant coronary pathophysiology?
Article in JACC. Cardiovascular imaging, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 112 papers, 4 of them syntheses that pooled it.
What it found
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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.
Effect of the Antidiabetic Drug DAPAgliflozin on the Coronary Macrovascular and MICROvascular Function in Type 2 Diabetic Patients
DEFINE-FLOW (Distal Evaluation of Functional Performance With Intravascular Sensors to Assess the Narrowing Effect - Combined Pressure and Doppler FLOW Velocity Measurements)
Who cites it
112 citing papers in PubMed, 4 syntheses or guidelines pooled it, 311 citations in OpenAlex.
- Angiography-based coronary microvascular assessment with and without intracoronary pressure measurements: a systematic review.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Pooled it
- Comparison of diagnostic accuracy of PET-derived myocardial blood flow parameters: A meta-analysis.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Pooled it
- Update of the Brazilian Guideline on Nuclear Cardiology - 2020.Arquivos brasileiros de cardiologia · 2020Guideline
- Functional Versus Anatomic Imaging of CAD: Lessons Learned from Recent Clinical Trials.Current cardiology reports · 2016Pooled it
- Trial
- Feasibility of dynamic stressEuropean journal of nuclear medicine and molecular imaging · 2018Trial
- The effect of coronary revascularization on regional myocardial blood flow as assessed by stress positron emission tomography.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2017Trial
- Fractional Flow Reserve Measurement Using Dynamic CT Perfusion Imaging in Patients with Heavy Coronary Calcification and Stent.Diagnostics (Basel, Switzerland) · 2026Article
- Coronary Flow Reserve in Adults: Pathophysiology, Assessment Modalities, Clinical Applications, and Prognostic Significance.Medicina (Kaunas, Lithuania) · 2026Review
- Beyond Stenosis: Mechanism-Based Multimodality Imaging and Invasive Coronary Function Testing for Endotype Definition in ANOCA/INOCA.Medicina (Kaunas, Lithuania) · 2026Review
- Sex Differences in Atherosclerotic Coronary Artery Disease Patterns.Journal of the American Heart Association · 2025Article
- Performance of a Novel Computational Hyperemic Resistance Index Derived from Cardiac CT in Coronary Chronic Syndromes.Journal of clinical medicine · 2025Article
- Myocardial flow reserve derived from D-SPECT for evaluating non-culprit ischemic lesions in STEMI patients: comparison with quantitative flow ratio.European journal of nuclear medicine and molecular imaging · 2025Article
- Coronary Microvascular Dysfunction in Ischaemic Heart Disease: Lessons From Large Animal Models.Basic & clinical pharmacology & toxicology · 2025Review
- Impact of coronary revascularization on coronary flow capacity measured by transthoracic Doppler echocardiography in patients with chronic coronary syndrome.Scientific reports · 2024Article
- Intracoronary ECG ST-segment shift remission time during reactive myocardial hyperemia: a new method to assess hemodynamic coronary stenosis severity.American journal of physiology. Heart and circulatory physiology · 2024Observational
- Hemodynamic Evaluation of Coronary Artery Lesions after Kawasaki Disease: Comparison of Fractional Flow Reserve during Cardiac Catheterization with Myocardial Flow Reserve duringJournal of cardiovascular development and disease · 2024Article
- Current status and perspectives of nuclear cardiology.Annals of nuclear medicine · 2024Review
- Predictors of discordance between fractional flow reserve (FFR) and diastolic pressure ratio (dPR) in intermediate coronary lesions.International journal of cardiology. Heart & vasculature · 2023Article
- Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass Grafting.Journal of the American Heart Association · 2023Article
52 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe purpose of this study was to determine whether observed discordance between coronary flow reserve (CFR) and fractional flow reserve (FFR) is due to methodology or reflects basic coronary pathophysiology.
backgroundDespite the clinical importance of coronary physiological assessment, relationships between its 2 most common tools, CFR and FFR, remain poorly defined.
methodsThe worst CFR and stress relative uptake were recorded from 1,500 sequential cardiac positron emission tomography cases from our center. From the literature, we assembled all combined, invasive CFR-FFR measurements, including a subset before and after angioplasty. Both datasets were compared with a fluid dynamic model of the coronary circulation predicting relationships between CFR and FFR for variable diffuse and focal narrowing.
resultsA modest but significant linear relationship exists between CFR and FFR both invasively (r = 0.34, p < 0.001) and using positron emission tomography (r = 0.36, p < 0.001). Most clinical patients undergoing CFR or FFR measurements have diffusely reduced CFR consistent with diffuse atherosclerosis or small-vessel disease. The theoretical model predicts linear relationships between CFR and FFR for progressive stenosis with slopes dependent on diffuse narrowing, matching observed data. Reported changes in CFR and FFR with angioplasty agree with model predictions of removing focal stenosis but leaving diffuse disease. Although CFR-FFR concordance is common, discordance is due to dominant or absent diffuse versus focal disease, reflecting basic pathophysiology.
conclusionsCFR is linearly related to FFR for progressive stenosis superimposed on diffuse narrowing. The relative contributions of focal and diffuse disease define the slope and values along the linear CFR and FFR relationship. Discordant CFR and FFR values reflect divergent extremes of focal and diffuse disease, not failure of either tool. With such discordance observed by invasive and noninvasive techniques and also fitting fluid dynamic predictions, it reflects clinically relevant basic coronary pathophysiology, not methodology.
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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.