Related Experiment Video
Updated: Aug 23, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Microvascular dysfunction in angiographically normal or mildly diseased coronary arteries predicts adverse
Martina B Britten1, Andreas M Zeiher, Volker Schächinger
1Department of Medicine IV, J.W. Goethe-University, Frankfurt, Germany.
Insights
Reduced coronary flow reserve predicts long-term cardiovascular events in patients with normal to mildly diseased arteries. This finding highlights coronary flow reserve as a key prognostic indicator for atherosclerosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) risk stratification often relies on traditional risk factors and anatomical assessment.
- Assessing functional significance of coronary lesions, particularly in non-obstructive CAD, remains a clinical challenge.
- Coronary flow reserve (CFR) offers a physiological measure of myocardial perfusion.
Purpose of the Study:
- To evaluate the predictive value of coronary flow reserve (CFR) for long-term cardiovascular event rates.
- To determine if CFR is an independent predictor of prognosis in patients with normal or minimally diseased coronary arteries.
Main Methods:
- Observational, longitudinal, single-center study involving 120 patients.
- Coronary flow reserve assessed using intracoronary Doppler and quantitative coronary angiography.
- Follow-up averaged 6.5 years, with cardiovascular events defined as death, myocardial infarction, unstable angina, stroke, or revascularization.
Main Results:
- A significantly higher rate of cardiovascular events was observed in patients with the lowest tertile of CFR (18%) compared to the middle (10%) and upper (5%) tertiles (P=0.019).
- Multivariate analysis identified CFR as an independent predictor of prognosis (P=0.017), alongside atherosclerosis (P=0.047) and hypertension (P=0.013).
Conclusions:
- Coronary flow reserve is a valuable independent predictor of long-term cardiovascular prognosis in patients with normal to mildly diseased coronary arteries.
- CFR assessment can enhance risk stratification for atherosclerosis over the next decade.
Objective:
To study the role of coronary flow reserve for the prediction of long-term cardiovascular event rate.
Design:
Observational, longitudinal.
Setting:
Single-center, coronary vasomotor testing at university hospital.
Participants:
One hundred and twenty patients with angiographically normal or minimally diseased coronary vessel.
Methods:
Coronary flow reserve was assessed by intracoronary Doppler and quantitative coronary angiography. Cardiovascular events during follow-up (6.5+/-3 years, range 14-125 months) were defined as sudden death, myocardial infarction, unstable angina, ischemic stroke or the need for revascularization by percutaneous transluminal coronary angioplasty or coronary as well as peripheral bypass surgery.
Results:
Reduced coronary flow reserve was significantly associated with a poor long-term outcome: cardiovascular events occurred in seven (18%) patients in the lowest tertile of coronary flow reserve compared with four patients in the middle tertile (10%) and two patients in the upper tertile (5%) (P=0.019 by Kaplan-Meier analysis). The multivariate Cox proportional hazard model revealed coronary flow reserve as an independent predictor of prognosis (P=0.017) in addition to angiographic evidence of atherosclerosis (P=0.047) and arterial hypertension (P=0.013).
Conclusions:
Coronary flow reserve in normal to mildly diseased arteries is an independent predictor of long-term prognosis of atherosclerosis within the next decade.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology