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August 27, 2026European Heart JournalOpen Access

A 0.1 unit decrease in coronary flow velocity reserve is linked to ~5% more major events.

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Why the study?

Many women with angina have no obstructive CAD yet face impaired prognosis, and whether routine assessment of coronary microvascular dysfunction is feasible and predictive of adverse outcomes was unknown.

Does coronary flow velocity reserve (CFVR) assessed by echocardiography predict adverse outcomes in women with angina and no obstructive coronary artery disease?

Population

1853 women with angina and no obstructive CAD on angiogram

Comparison

Coronary flow velocity reserve assessment by Doppler echocardiography

Design

Prospective cohort study

Follow-up

Median 4.5 years

Key result

A 0.1 unit decrease in coronary flow velocity reserve was associated with increased risk of cardiovascular death, MI, heart failure, stroke, or revascularization (HR 1.05; 95% CI 1.01-1.09; P=0.01).

Authors

JSJakob SchrøderMMMarie Mide MichelsenNMNaja Dam Mygind

Discussion

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Member takes

Overview

CMD assessment by echocardiography may identify higher-risk women; leaves open whether targeting CMD improves outcomes.

Key Points

  • To evaluate whether measuring coronary flow velocity reserve via Doppler echocardiography is feasible and prognostic for adverse cardiovascular events in women with angina and nonobstructive coronary artery disease.
  • Enrolled 1,853 women with angina and no obstructive CAD on coronary angiography, without prior heart failure or valvular disease, in the prospective iPOWER cohort.
  • Assessed coronary microvascular dysfunction via Doppler echocardiography of the left anterior descending artery to determine coronary flow velocity reserve (CFVR).
  • Followed participants for a median of 4.5 years for a composite outcome of cardiovascular death, myocardial infarction, heart failure, stroke, and revascularization.
  • CFVR was successfully measured in 91% of patients (n=1,681; median CFVR 2.33), with 96 composite events recorded over follow-up.
  • Lower CFVR independently predicted the primary composite outcome in multivariate Cox regression (HR 1.05 per 0.1 unit decrease, 95% CI 1.01–1.09; P = 0.01), driven primarily by increased risk of myocardial infarction and heart failure.

Study Design

Type

Cohort (n=1,853)

Structured PICO

Does coronary flow velocity reserve (CFVR) assessed by echocardiography predict adverse outcomes in women with angina and no obstructive coronary artery disease?

P
Population
1,853 women with angina and no obstructive CAD, free of previous CAD, heart failure, or valvular heart disease, followed for a median of 4.5 years.
E
Exposure
Assessment of coronary microvascular dysfunction (CMD) via coronary flow velocity reserve (CFVR) using Doppler echocardiography in the left anterior descending artery.
O
Outcome
Composite outcome of cardiovascular death, myocardial infarction (MI), heart failure, stroke, and coronary revascularization at median 4.5 years follow-up.composite

Main Result

Hazard Ratio: 1.05 (95% CI 1.01–1.09)

p-value: p=0.01

Non-invasive assessment of coronary flow velocity reserve by echocardiography is feasible and independently predicts adverse cardiovascular outcomes in women with angina and no obstructive CAD.

Cite This Study

Schrøder et al. (2020) conducted a cohort in Angina and no obstructive coronary artery disease (n=1,853). Coronary flow velocity reserve (CFVR) was evaluated on Composite outcome of cardiovascular death, myocardial infarction (MI), heart failure, stroke, and coronary revascularization (HR 1.05, 95% CI 1.01-1.09, p=0.01). A 0.1 unit decrease in coronary flow velocity reserve was associated with increased risk of cardiovascular death, MI, heart failure, stroke, or revascularization (HR 1.05; 95% CI 1.01-1.09; P=0.01).

synapsesocial.com/papers/6a9000fd2e4bea8bbd45c696https://doi.org/10.1093/eurheartj/ehaa944
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Also Consider

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

  1. 1Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms2021 · 6 citations
  2. 2Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease: The iPOWER Study2017 · 13 citations
  3. 3Resting coronary velocity and myocardial performance in women with impaired coronary flow reserve: Results from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study2020 · 19 citations
  4. 4Coronary microvascular dysfunction is associated with cardiac time intervals in women with angina and no obstructive coronary artery disease: An <scp>iPOWER</scp> substudy2019 · 6 citations
  5. 5Coronary flow velocity reserve reduction by Doppler echocardiography and independent association with mortality in patients with normal coronary arteries2025