Assessment of coronary flow reserve and microcirculation: A clinical perspective

Myocardial perfusion imaging remains a powerful tool for evaluating the entire spectrum of severity in the natural history of coronary atherosclerosis. Although measures of ischemic burden (ie, perfusion defects) remain the primary endpoint of interest in the noninvasive evaluation of obstructive CAD, measures of MBF and coronary vasodilator reserve may be better suited for delineating populations at risk in preclinical stages of atherosclerosis. The data presented above demonstrate the value of measures of coronary vasodilator function for early detection of patients at risk for CAD and for monitoring the effects of therapeutic interventions. Detection of patients at risk may offer an opportunity for early medical intervention aimed at halting the progression of atherogenesis and ultimately lead to a reduction in cardiovascular events.