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Coronary Flow Velocity Reserve by Echocardiography: Beyond Atherosclerotic Disease
Giovanni Civieri1, Roberta Montisci2, Peter L M Kerkhof3
1Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy.
Insights
Echocardiography offers a non-invasive method to assess Coronary Flow Velocity Reserve (CFVR), aiding in the detection of microvascular dysfunction and patient risk stratification. This technique is valuable for evaluating coronary involvement in systemic diseases.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Biology
Background:
- Coronary Flow Velocity Reserve (CFVR) is crucial for assessing coronary artery health.
- Traditional CFVR measurement methods are invasive or involve radiation, limiting widespread use.
- Echocardiography has emerged as a reliable, non-invasive alternative for CFVR assessment.
Purpose of the Study:
- To review the diverse applications of echocardiography-derived CFVR.
- To highlight the role of CFVR in assessing coronary microcirculation.
- To focus on the utility of CFVR in evaluating coronary involvement in systemic diseases.
Main Methods:
- Utilizing echocardiography to measure CFVR.
- Assessing coronary flow velocity during hyperemia and at rest.
- Correlating CFVR findings with various systemic conditions.
Main Results:
- Echocardiography-based CFVR accurately assesses hemodynamic significance and microcirculation.
- Microvascular dysfunction is identifiable in conditions like cardiomyopathies, inflammatory, and metabolic diseases.
- CFVR by echocardiography serves as a prognostic factor for patient risk stratification.
Conclusions:
- Echocardiography-derived CFVR is a versatile tool for evaluating coronary microcirculation.
- It effectively detects microvascular dysfunction across a spectrum of systemic diseases.
- CFVR assessment via echocardiography provides valuable prognostic information for patient management.
Abstract:
Coronary flow velocity reserve (CFVR) is defined as the ratio between coronary flow velocity during maximal hyperemia and coronary flow at rest. Gold-standard techniques to measure CFVR are either invasive or require radiation and are therefore inappropriate for large-scale adoption. More than 30 years ago, echocardiography was demonstrated to be a reliable tool to assess CFVR, and its field of application rapidly expanded. Although initially validated to assess the hemodynamic relevance of a coronary stenosis, CFVR by echocardiography was later used to investigate coronary microcirculation. Microvascular dysfunction was detected in many different conditions, ranging from organ transplantation to inflammatory disorders and from metabolic diseases to cardiomyopathies. Moreover, it has been proven that CFVR by echocardiography not only detects coronary microvascular involvement but is also an effective prognostic factor that allows a precise risk stratification of the patients. In this review, we will summarize the many applications of CFVR by echocardiography, focusing on the coronary involvement of systemic diseases.
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