Long-term prognostic significance of CFR for prediction of cardiovascular morbidity and mortality has been demonstrated during a 9-year follow-up in patients with AS. Despite a relatively small number of patients were followed, CFR was found to be an independent predictor for future cardiovascular events in AS patients.

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Vascular functional alterations frequently precede morphological changes and, therefore, their recognition may theoretically improve early detection of vascular injury. The aim of this review is to demonstrate recently available non-invasive clinical methods including vascular stiffness examinations, flow-mediated vasodilatation, coronary flow reserve and myocardial flow reserve measurements.

Background:The coronary flow velocity reserve (CFR) has proven to be an important diagnostic tool that provides relevant physiological information regarding the function of the left anterior descending coronary artery (LAD). The Elastic modulus (E(p)) and Young's modulus (E(s)) are functional markers of the aortic distensibility. The aim of the present study was to examine the predictive value of the cardiac risk factors, CFR, mean CFR, E(p) and E(s) in the evaluation of patients with aortic plaque (grade 2-3 aortic atherosclerosis). Methods and Patients: A total of 113 consecutive patients (77 men and 36 women, aged 31 to 80 years) underwent stress transesophageal echocardiographic assessment of CFR. The CFR was calculated by the ratio of average peak diastolic flow velocity (APV) during hyperemia to resting APV. The mean CFR was calculated by the ratio of average mean diastolic flow velocity (AMV) during hyperemia to resting AMV. All patients had stable angina pectoris without previous myocardial infarction. The coronary angiography was performed in all cases. During transesophageal echocardiography, aortic atherosclerosis (AA) was also evaluated: grade 0: no atherosclerosis, grade 1: intimal thickening, grade 2: aortic plaque <5mm, grade 3: aortic plaque >5mm, grade 4: mobile parts. Cases with grade 4 aortic atherosclerosis were not found in this patient population. Results: The age (ROC area, 90%, p<0.01), the CFR (ROC area, 80%, p<0.01), the mean CFR (ROC area, 79%, p<0.01), the E(p) (ROC area, 77%, p<0.01) and the E(s) (ROC area, 65%, p<0.05) displayed good value for the prediction of patients with aortic plaque from cases without aortic atherosclerosis. Conclusion:The age and the functional parameters of aorta and LAD have a predictive value in the evaluation of patients with grade 2-3 aortic atherosclerosis.