Functional anatomy of myocardial perfusion

The continuous development of cardiac imaging modalities in recent years has led to a better understanding of myocardial perfusion on a structural level by allowing detection of myocardial blood flow alterations caused by obstructed coronary arteries or different cardiac pathologies. Apart from direct visualization of the epicardial coronary arteries by coronary angiography or cardiac computed tomography, the diagnosis of functionally relevant stenosis often requires additional techniques such as invasive fractional flow reserve measurements. The possibility of a non-invasive assessment of coronary perfusion status including pathologies which may otherwise evade detection by standard angiography, such as microvascular disease, by imaging modalities such as single-photon emission computed tomography and cardiovascular magnetic resonance imaging has significantly changed clinical management of patients with suspected or known coronary artery disease. Using an integrated diagnostic approach combining functional information gained by perfusion studies and structural data covering coronary anatomy, the planning of interventional procedures and further risk stratification may be significantly improved.