Evaluation of Myocardial Blood Flow and Metabolism

Measurement of myocardial blood flow for research studies and in clinical practice has enhanced our understanding of the coronary circulation in health and disease. Despite the refinements in measurement techniques of epicardial coronary anatomy provided by quantitative angiographic techniques and, more recently, by intravascular ultrasound, direct measurement of coronary blood flow provides important additional insights into functional aspects of coronary artery disease. In this chapter, we will review the wide variety of techniques that have been used to evaluate myocardial metabolism and blood flow with a focus on catheter-based methods. Particular emphasis will be placed on intracoronary translesional Doppler flow velocity and pressure measurements as simple and safe techniques for determination of coronary artery blood flow that can be clinically applied in the cardiac catheterization laboratory.