Goal: To indicate the influence of risk factors for the development of coronary artery disease (CAD) on coronary flow reserve (CFR) values assessed by transthoracic echocardiography (TTE) ​​in patients without verified CAD.

Methods: The paper presents an analysis of the available literature from reference databases covering the mentioned topic.

Results: TTE-CFR presents a ratio of hyperaemic coronary blood flow during maximum vasodilation in relation to resting coronary blood flow. The most commonly used vasodilators are dipyridamole and adenosine (adenosine 140 mcg⁄kg⁄min (1-2 min), dipyridamole 0.84 mg⁄kg⁄6 min). Age and female gender have a lesser effect on the values of hyperemic CFR. Ethnic differences (vascularization, left ventricle structure) can influence the CFR values. Also, obesity, smoking, hyperlipidemia, elevated values ​​of low-density lipoproteins (LDL), arterial hypertension, diabetes mellitus, and obstructive sleep apnea in a healthy population can have a negative effect on CFR values.

Conclusion: There is evidence of the effect of risk factors for CAD on CFR values ​​in a population without established pathology. (1-3) It is a marker of the early stages of coronary atherosclerosis (a tool in the stratification of patients regarding cardiovascular risk, and it could be a guide in the primary prevention of cardiovascular disease). Also, TTE-CFR<2 has good sensitivity and specificity to predict the significance of stenosis. Clinical presentation of the patient should be a part of the mosaic of interpretation of test results. CFR is an additional test, and stress echocardiography presents the first choice in the evaluation of ischemic heart disease.