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February 8, 2026European Heart Journal

Prognostic value of coronary flow velocity reserve in obese patients with preserved ejection fraction and negative stress echocardiography

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Why the study?

Coronary microvascular dysfunction represents an early marker of cardiovascular disease, but the prognostic significance of coronary flow velocity reserve in overweight and obese patients needed evaluation.

Does coronary microvascular dysfunction assessed via CFVR predict overall mortality in overweight or obese patients with preserved EF and negative stress echocardiography?

Population

2273 overweight or obese patients with normal EF and negative stress echocardiography

Comparison

Presence of coronary microvascular dysfunction (CMD) vs absence of CMD

Design

Prospective multicenter cohort study

Follow-up

Median 2.1 years (IQR: 1.2-3.7 years)

Key result

Coronary microvascular dysfunction (CFVR ≤ 2.0) independently increased long-term mortality risk by 80% (HR 1.8) in obese patients with preserved EF and negative stress echo.

Authors

FMFrancesca MantovaniCCChirino CiampiABA Barbieri

Discussion

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Member takes

Overview

May identify higher-risk obese patients despite negative stress echo; hypothesis-generating and should not yet change practice.

Key Points

  • To assess the prognostic significance of coronary flow velocity reserve (CFVR) in obese patients with preserved ejection fraction and negative stress echocardiography.
  • Included 2273 patients from 27 sites across 11 countries.
  • Patients classified as overweight or obese with preserved ejection fraction underwent stress echocardiography.
  • Coronary flow velocity reserve of the left anterior descending artery was measured to identify coronary microvascular dysfunction.
  • Coronary microvascular dysfunction detected in 22% of patients.
  • 103 patients (5%) died during a median follow-up of 2.1 years.
  • Patients with coronary microvascular dysfunction had significantly lower six-year survival rates compared to those without.

Structured PICO

Does coronary microvascular dysfunction assessed via CFVR predict overall mortality in overweight or obese patients with preserved EF and negative stress echocardiography?

P
Population
2273 overweight or obese patients (mean age 65 ± 11 years; 51% women) with normal left ventricular ejection fraction (EF ≥ 50%), no prior history of CAD, and negative exercise or pharmacological stress echocardiography for inducible ischemia.
I
Intervention
Presence of coronary microvascular dysfunction (CMD) assessed via coronary flow velocity reserve (CFVR) during stress echocardiography (defined in text as CFVR >2.0)
C
Comparator
Absence of coronary microvascular dysfunction (CMD)
O
Outcome
Overall mortalityhard clinical

Coronary microvascular dysfunction assessed by CFVR during stress echocardiography is an independent predictor of long-term mortality in overweight and obese patients with preserved EF and no inducible ischemia.

Cite This Study

Mantovani et al. (2025) studied this question. Coronary microvascular dysfunction (CFVR ≤ 2.0) independently increased long-term mortality risk by 80% (HR 1.8) in obese patients with preserved EF and negative stress echo.

synapsesocial.com/papers/698828990fc35cd7a8848368https://doi.org/10.1093/eurheartj/ehaf784.111
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