{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:03:39Z","timestamp":1791237819887,"version":"4.1.0"},"reference-count":142,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Coronary flow reserve (CFR) is a fundamental physiological index defined as the ratio of maximal coronary blood flow during hyperemia to resting flow. It provides an integrated assessment of the entire coronary circulation, from epicardial arteries to the microvasculature. Non-invasive assessment, particularly with transthoracic Doppler echocardiography (TTDE), is valuable in clinical practice for evaluating the functional impact of moderate obstructive lesions and determining the status of coronary microcirculation. Impairment of coronary microcirculation, detected by reduced CFR, is present in diverse conditions such as Tako-Tsubo cardiomyopathy, cardiac syndrome X, hypertension, and slow coronary flow. CFR also serves as a non-invasive tool to examine the effects of various interventions. CFR can be assessed invasively using Doppler guidewire or thermodilution techniques and non-invasively using transthoracic Doppler echocardiography, PET, CMR, CT perfusion, and dynamic SPECT. Lower CFR is observed with advancing age, in females, and in individuals of African descent. An impaired CFR is a powerful, independent predictor of major adverse cardiovascular events (MACEs) across a wide spectrum of diseases, including stable obstructive coronary artery disease (CAD), ischemic syndromes with no obstructive coronary arteries (INOCAs), heart failure, cardiomyopathies, and systemic diseases like diabetes and chronic kidney disease. Beyond risk stratification, CFR is used to guide therapeutic decisions, including revascularization strategies and tailoring of pharmacological interventions. The integration of CFR assessment into clinical practice, supported by recent guideline recommendations, represents a shift towards personalized, physiology-based cardiovascular care.<\/jats:p>","DOI":"10.3390\/medicina62061035","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:02:51Z","timestamp":1779793371000},"page":"1035","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Coronary Flow Reserve in Adults: Pathophysiology, Assessment Modalities, Clinical Applications, and Prognostic Significance"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1631-5210","authenticated-orcid":false,"given":"Konstantinos","family":"Katogiannis","sequence":"first","affiliation":[{"name":"2nd Cardiology Department, General Hospital \u201cAttikon\u201d, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4890-5111","authenticated-orcid":false,"given":"Jimmy T.","family":"Efird","sequence":"additional","affiliation":[{"name":"VA Cooperative Studies Program Coordinating Center, Massachusetts Veterans Epidemiology Research and Information Collaborative (MAVERIC), Boston, MA 02111, USA"},{"name":"School of Medicine, Case-Western Reserve University, Cleveland, OH 44206, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2100-5076","authenticated-orcid":false,"given":"Artur","family":"Dziewierz","sequence":"additional","affiliation":[{"name":"Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland"},{"name":"Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5547-4025","authenticated-orcid":false,"given":"Francisco","family":"Epelde","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Parc Taul\u00ed Hospital Universitari, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona, 08208 Sabadell, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8241-7886","authenticated-orcid":false,"given":"Ignatios","family":"Ikonomidis","sequence":"additional","affiliation":[{"name":"2nd Cardiology Department, General Hospital \u201cAttikon\u201d, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1161\/01.CIR.97.16.1557","article-title":"Noninvasive assessment of significant left anterior descending coronary artery stenosis by coronary flow velocity reserve with transthoracic color Doppler echocardiography","volume":"97","author":"Hozumi","year":"1998","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/S0735-1097(98)00389-1","article-title":"Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography: Comparison with invasive technique","volume":"32","author":"Homuzi","year":"1998","journal-title":"J. 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