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
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May better identify high-risk patients with angina and nonobstructive CAD; extends models beyond CFVR but remains hypothesis-generating.
Cohort (n=381)
Does hyperemic coronary flow velocity (hCFV) improve risk prediction for MACE in patients with angina and nonobstructive coronary artery disease?
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.
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).
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