Coronary flow velocity reserve (CFVR)<2 measured by Doppler echocardiography doubled all-cause mortality risk (HR 2.01) in patients with normal coronary arteries.
Does reduced coronary flow velocity reserve (CFVR < 2) measured by Doppler echocardiography predict all-cause mortality in patients with chest pain and normal epicardial coronary arteries?
Reduced coronary flow velocity reserve (<2) assessed by non-invasive Doppler echocardiography is an independent predictor of all-cause mortality in patients with coronary microvascular disease and normal epicardial arteries.
Abstract Background To date there is no published study investigating the potential prognostic effect of coronary flow reserve (CFR), assessed either with invasive or non-invasive modalities, specifically on future mortality in patients with angiographically-confirmed normal epicardial coronary arteries, i.e. coronary microvascular disease (CMD). Non-invasive assessment of CFR is definitely more practical than the invasive one if the aim is the collection of CFR data in an adequate high number of patients, only a small fraction of whom will show normal coronary arteries at coronary angiography. Methods We leveraged our vasodilator-echocardiography registry to assess mortality in those patients who presented with normal left ventricle function and chest pain and who also underwent coronary angiography demonstrating the absence of epicardial coronary artery stenosis. In the registry coronary flow velocity reserve (CFVR) was routinary measured with Doppler in the left anterior descending coronary artery (LAD) during the index accelerated high-dose Dipyridamole echocardiogram. Results We selected 637 patients with normal baseline echocardiogram, angiographically normal epicardial coronary arteries (only modified Duke score=1) who underwent DE with CFVR for suspected CAD symptoms. All-cause death was recorded in 44 patients (7.2%) and CFVR2 was present in 129 (20%) while ischemia based on reversible wall motion abnormalities (RWMA) in 16 (2.5%). Figure 1 shows the ROC curve for CFVR versus mortality, AUC=0.731, p0.001. Only age, RWMA and CFVR2 (Figure 2) were associated with mortality at univariate analysis, while multivariate analysis reported only age (HR 1.11, 95% CI 1.07-1.16, p0.001) and CFVR2 (HR 2.01, 95% CI 1.07-3.77, p0.029) as independently associated with the mortality endpoint. Conclusions This is the first study ever reporting that CFVR measured by echocardiography is significantly and independently associated with all-cause mortality in patients with CMD and no epicardial coronary disease. Further, no other non-invasive modality has ever demonstrated risk stratifying capability in such primary CMD patients with regard to mortality.Receiver operating curve for CFVR/death K-M curve for reduced CFVR and mortality
Gaibazzi et al. (2025) studied this question. Coronary flow velocity reserve (CFVR)<2 measured by Doppler echocardiography doubled all-cause mortality risk (HR 2.01) in patients with normal coronary arteries.