Centre cardiologique du Nord, 32-36 rue des Moulins-Gémeaux, 93207 Saint-Denis Cedex
Coronary flow velocity reserve (CVR) is an important parameter for understanding of the pathophysiology of the whole coronary circulation. Its use has for a long time been hampered by the lack of a non invasive assessment method. Within the last few years, the technology of transthoracic Doppler echocardiography (TDE) has developed and allows now for non invasive assessment of CVR. This method is repeatable, inexpensive, does not use radioactive compounds, and can be performed at the bedside and on an outpatient basis. The clinical field of applications is large. It may provide additional information to the coronary angiogram in the assessment of coronary stenosis, especially for those of intermediate anatomic severity. In patients without coronary stenosis, CVR allows the detection of coronary microcirculatory disorders, which are frequently seen in the presence of diabetes mellitus, dyslipidemia or idiopathic cardiomyopathy. Because of its non invasive nature, TDE allows serial assessment of CVR. This may be useful for systematic follow-up after coronary stenting to detect in-stent restenosis or to assess the patency of an arterial graft. Furthermore, CVR may also become a new non invasive tool for evaluating drug effects on the coronary microcirculation.