Related Experiment Video
Updated: Dec 25, 2025
Author Spotlight: Improved Localization and Monitoring of Coronary Flow Reserve Using Modified PLAX View in Mice
Published on: August 25, 2023
Clinical, hemodynamic, and functional variables affecting success rate of coronary flow velocity reserve detection
Lauro Cortigiani1, Francesco Bovenzi1, Eugenio Picano2
1Cardiology Division, San Luca Hospital, Lucca, Italy.
Insights
Stress echocardiography (SE) with coronary flow velocity reserve (CFVR) is highly feasible for assessing coronary artery disease. Factors like high heart rate, obesity, and anterior ischemia can impact SE-CFVR success rates.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Stress echocardiography (SE) is a key tool for evaluating coronary artery disease (CAD).
- Coronary flow velocity reserve (CFVR) measured via Doppler adds functional assessment to SE.
- Assessing factors influencing SE-CFVR success is crucial for optimizing diagnostic yield.
Purpose of the Study:
- To identify variables affecting the success rate of stress echocardiography with coronary flow velocity reserve (SE-CFVR).
- To evaluate the feasibility of SE-CFVR in a large patient cohort referred for suspected or known coronary syndromes.
Main Methods:
- A prospective, observational study of 2989 patients undergoing SE without contrast.
- CFVR measured as stress/rest peak diastolic flow velocity in the left anterior descending artery (LAD).
- Multivariable logistic regression used to identify predictors of unfeasible CFVR.
Main Results:
- An overall SE-CFVR feasibility of 93.9% was achieved, with success rates improving over time.
- Feasibility was similar across genders and body mass index (BMI) categories.
- Predictors of unfeasible CFVR included high resting heart rate (≥77 bpm), BMI ≥30 in women, and stress-induced LAD ischemia.
Conclusions:
- Vasodilator SE with CFVR is highly feasible, even without contrast.
- High resting heart rate, obesity in women, and anterior ischemia are associated with lower SE-CFVR success.
- These findings help refine patient selection and interpretation of SE-CFVR.
Aim:
Stress echocardiography (SE) with state-of-the-art imaging protocol allows a comprehensive assessment of regional wall-motion abnormalities and Doppler-based coronary flow velocity reserve (CFVR) in left anterior descending artery (LAD). We sought to assess the variables potentially impacting on success rate of SE with CFVR.
Methods And Results:
In a single-center, prospective, observational study design, from 2007 to 2019, we enrolled 2989 consecutive patients (age 67 ± 12 years; 1723 men) referred for SE, without contrast, for chronic known (n = 1130) or suspected (n = 1859) coronary syndromes. Coronary flow velocity reserve was measured as stress/rest peak diastolic flow velocity. The same operator (LC) performed all examinations with the same machine (GE Vivid 7). Interpretable CFVR was obtained in 2808 patients (feasibility = 93.9%). Overall success rate was lowest (91.4%) in 2007-2008 and steadily rose to 97.8% in 2017-2019 (P for trend <.0001). Feasibility was excellent for men (93.7%) and women (94.3%) (P = .47) across all values of body mass index (BMI): <25 (P = .09), 25-29 (P = .84), and ≥30 (P = .23). At multivariable logistic regression analysis, women with BMI ≥ 30 (OR 1.94, 95% CI 1.14-3.29, P = .02), resting heart rate ≥77 beats/min (OR 2.25, 95% CI 1.64-3.11; P < .0001), and stress-induced ischemia in the LAD territory (OR 3.14, 95% CI 1.67-5.90; P < .0001) predicted unfeasible CFVR.
Conclusion:
Vasodilator SE with CFVR combined with wall-motion analysis is highly feasible also without contrast although with a slight decline in presence of high resting heart rate (reducing diastolic time essential for flow imaging), women with BMI ≥ 30 (increasing tissue thickness interposed between transducer and artery), and anterior ischemia (for underlying low-absent anterograde flow for severely stenotic or occluded LAD).
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Pathophysiology of Cardiac Performance