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April 14, 2026MedCommOpen Access

Reduced hyperemic coronary flow velocity linked to ~560% higher MACE risk in ANOCA with CFVR <2.5.

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Why the study?

Risk stratification in patients with ANOCA remains suboptimal, and CFVR is susceptible to hemodynamic variability, prompting evaluation of whether hCFV improves risk prediction.

Does hyperemic coronary flow velocity (hCFV) improve risk prediction for MACE in patients with angina and nonobstructive coronary artery disease?

Population

246 consecutively enrolled ANOCA patients plus an independent validation cohort of 135

Comparison

Risk prediction with hCFV added to CFVR and clinical factors vs CFVR alone

Design

Cohort study with an independent validation cohort

Follow-up

Median 28.8 months

Key result

Reduced hyperemic coronary flow velocity (≤ 0.44 m/s) independently predicted major adverse cardiovascular events in ANOCA patients with CFVR < 2.5 (adjusted HR 6.6, p=0.001).

Authors

QLQuande LiuGJGuihua JiangMXMei‐Yan Xu

Discussion

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Overview

May better identify high-risk patients with angina and nonobstructive CAD; extends models beyond CFVR but remains hypothesis-generating.

Key Points

  • To evaluate whether hyperemic coronary flow velocity enhances risk prediction for major adverse cardiovascular events in patients with angina and nonobstructive coronary artery disease.
  • Analyzed data from 246 consecutively enrolled ANOCA patients and a validation cohort of 135 patients.
  • Measured coronary flow velocity reserve and hyperemic coronary flow velocity using transthoracic Doppler.
  • Tracked major adverse cardiovascular events over a median follow-up of 28.8 months.
  • 27 patients (10.9%) experienced major adverse cardiovascular events during the follow-up period.
  • Hyperemic coronary flow velocity independently predicted major adverse cardiovascular events among patients with CFVR < 2.5.
  • Combined CFVR and hyperemic coronary flow velocity improved stratification for risk of adverse events.

Study Design

Type

Cohort (n=381)

Structured PICO

Does hyperemic coronary flow velocity (hCFV) improve risk prediction for MACE in patients with angina and nonobstructive coronary artery disease?

P
Population
381 patients (246 derivation cohort, 135 validation cohort) with angina and nonobstructive coronary arteries (ANOCA)
I
Intervention
Hyperemic coronary flow velocity (hCFV) measurement via transthoracic Doppler of the mid-distal LAD
C
Comparator
Coronary flow velocity reserve (CFVR) and clinical risk factors alone
O
Outcome
Major adverse cardiovascular events (MACE) at median 28.8 months follow-upcomposite

Main Result

Effect estimate: adjusted HR 6.6

Absolute Event Rate: 35.5% vs 10.5%

p-value: p=0.001

Reduced hyperemic coronary flow velocity provides incremental prognostic value beyond coronary flow velocity reserve for identifying high-risk patients with angina and nonobstructive coronary arteries.

Cite This Study

Liu et al. (2026) conducted a cohort in Angina and nonobstructive coronary arteries (ANOCA) (n=381). Hyperemic coronary flow velocity (hCFV) assessment vs. Higher hCFV (>0.44 m/s) or CFVR alone was evaluated on Major adverse cardiovascular events (MACE) (adjusted HR 6.6, p=0.001). Reduced hyperemic coronary flow velocity (≤ 0.44 m/s) independently predicted major adverse cardiovascular events in ANOCA patients with CFVR < 2.5 (adjusted HR 6.6, p=0.001).

synapsesocial.com/papers/69ddda4de195c95cdefd7bdfhttps://doi.org/10.1002/mco2.70731
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prognostic value of Doppler echocardiographic-derived coronary flow velocity reserve of left anterior descending artery in octogenarians with stress echocardiography negative for wall motion criteria2015 · 24 citations
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  4. 4&lt;p&gt;PROspective evaluation of coronary FLOW reserve and molecular biomarkers in patients with established coronary artery disease the PROFLOW-trial: cross-sectional evaluation of coronary flow reserve&lt;/p&gt;2019 · 7 citations
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