MedComm (2020). 2026 Apr 12;7:e70731. doi: 10.1002/mco2.70731. eCollection 2026 Apr.
ABSTRACT
Risk stratification in patients with angina and nonobstructive coronary arteries (ANOCA) remains suboptimal. Coronary flow velocity reserve (CFVR) is prognostic but susceptible to hemodynamic variability; we evaluated whether hyperemic coronary flow velocity (hCFV) improves risk prediction. We analyzed 246 consecutively enrolled ANOCA patients and an independent validation cohort (n = 135). Transthoracic Doppler of the mid-distal LAD quantified CFVR and hCFV. The primary end point was major adverse cardiovascular events (MACE). During a median follow-up of 28.8 months, 27 patients (10.9%) experienced MACE. Both CFVR and hCFV were significantly associated with MACE. Among patients with CFVR < 2.5, hCFV ≤ 0.44 m/s independently predicted MACE (adjusted HR 6.6, p = 0.001). A combined CFVR-hCFV scheme yielded graded risk of MACE (Group A: CFVR ≥ 2.5; Group B: CFVR < 2.5 with hCFV > 0.44 m/s; Group C: CFVR < 2.5 with hCFV ≤ 0.44 m/s), with Group C exhibiting the highest risk of MACE (35.5% vs. 6.3%, 10.5%, p < 0.01). Adding reduced hCFV to a model including clinical risk factors and CFVR improved prediction (IDI 0.05, p = 0.011; NRI 0.23, p = 0.0023) and was confirmed in the validation cohort. Reduced hCFV provides incremental prognostic value beyond CFVR and offers a practical approach to identify high-risk ANOCA patients.
PMID:41978827 | PMC:PMC13070199 | DOI:10.1002/mco2.70731