Table 1

Summary of advantages and disadvantages of different modalities used to assess coronary flow reserve

ModalityAdvantagesDisadvantages
Invasive angiography (Doppler and thermodilution)

  1. Definitive exclusion of epicardial coronary artery disease

  2. Widely available

  1. Invasive procedure

  2. Ionising radiation

Positron emission tomography

  1. Non-invasive

  2. Can assess myocardial ischaemia and scar

  3. Allows calculation of regional and global myocardial blood flow

  1. Ionising radiation

  2. Not widely available in UK

Coronary sinus flow

  1. Non-invasive

  2. Sequences and analysis are quick to perform

  1. Contraindications to MRI limit its widespread use

First pass perfusion

  1. Non-invasive

  2. Can assess myocardial ischaemia and scar

  3. Myocardial viability can be ascertained

  1. Requires gadolinium limiting its utility in chronic kidney disease

  2. Scan sequences can be lengthy to perform and analyse

  3. Contraindications to MRI limit its widespread use

Stress T1 mapping

  1. Non-invasive

  2. Provides additional myocardial tissue characterisation

  1. Contraindications to MRI limit its widespread use

  2. Not well validated

Doppler transthoracic echo

  1. Non-invasive

  2. Cheap

  3. Portable

  1. Only assesses left anterior descending artery territory

Myocardial contrast echo

  1. Non-invasive

  2. Cheap

  3. Portable

  4. Allows calculation of regional and global myocardial blood flow

  1. Requires good acoustic windows