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The Incremental Prognostic Value of Hyperemic Coronary Flow Velocity in Patients with Angina and Nonobstructive

Quande Liu1,2,3, Guihua Jiang1,2,3, Mingjun Xu1,2,3

  • 1National Key Laboratory for Innovation and Transformation of Luobing Theory Jinan China.

Medcomm
|April 14, 2026
PubMed

Insights

Hyperemic coronary flow velocity (hCFV) improves risk prediction in angina with nonobstructive coronary arteries (ANOCA) patients. Combining hCFV with coronary flow velocity reserve (CFVR) identifies high-risk individuals, enhancing cardiovascular event prediction.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Clinical Risk Stratification

Background:

  • Risk stratification in angina with nonobstructive coronary arteries (ANOCA) is challenging.
  • Coronary flow velocity reserve (CFVR) is prognostic but limited by hemodynamic variability.
  • Hyperemic coronary flow velocity (hCFV) may offer improved prognostic value.

Purpose of the Study:

  • To evaluate if hCFV improves risk prediction in ANOCA patients compared to CFVR alone.
  • To assess the prognostic value of hCFV in predicting major adverse cardiovascular events (MACE).
  • To develop a combined CFVR-hCFV scheme for graded risk stratification.

Main Methods:

  • Analysis of 246 ANOCA patients and a validation cohort (n=135).
  • Transthoracic Doppler measurement of CFVR and hCFV in the mid-distal LAD.
  • Assessment of MACE as the primary endpoint during follow-up.

Main Results:

  • Both CFVR and hCFV were significantly associated with MACE.
  • In patients with CFVR < 2.5, hCFV ≤ 0.44 m/s independently predicted MACE (aHR 6.6).
  • A combined CFVR-hCFV scheme demonstrated graded MACE risk, with the highest risk in Group C (CFVR < 2.5, hCFV ≤ 0.44 m/s).
  • Reduced hCFV added incremental prognostic value to clinical factors and CFVR, improving prediction (IDI 0.05, NRI 0.23).

Conclusions:

  • Reduced hCFV provides independent prognostic information beyond CFVR in ANOCA patients.
  • A combined CFVR-hCFV approach offers a practical method for identifying high-risk ANOCA individuals.
  • hCFV enhances cardiovascular risk prediction in ANOCA, aiding clinical decision-making.

Keywords:
angina with nonobstructive coronary arteriescoronary flow velocity reservecoronary microvascular dysfunctionhyperemic coronary flow velocitytransthoracic Doppler echocardiography

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