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Impaired coronary flow reserve (CFR) has a prognostic value in CAD patients. Aortic wall properties wall properties and wave reflections determine coronary perfusion, LV function and have and independent prognostic value. We investigated the association of aortic stiffness an abnormal wave reflection with resting coronary flow and coronary flow reserve (CFR) in CAD patients after revascularisation.Methods: We assessed in 55 patients with CAD and who underwent PCI in LAD or CABG within 6 months. We measured pulse wave velocity using both the Complior (carotid to femoral-PWVc) and Arteriograph apparatus (PWVa-oscillometric method). By means of pulse wave analysis (Arteriograph apparatus) we calculated the central aortic systolic blood pressure (cSBP-mmHg),the return time (RT-ms) and augmentation index (AI) of the arterial wave reflection, the diastolic area (DAI%) of the aortic pulse wave and diastolic reflection area (DRA) an index of diastolic filling of coronary arteries derived by duration of diastole and area between the expected area of the diastolic pressure curve without wave reflection and the true area with reflection. Coronary flow reserve (CFR) of the LAD after adenosine infusion was assessed using Doppler echocardiography Patients were categorised to those with either normal (>2.5) or impaired (<2.5) CFRResults: A decreasing CFR was related with increasing PWVc (r=0.44, p<0.05) PWVa (r=0.45, p<0.05), SBPc (r=0.49, p<0.001), RT, (r=0.45 p<0.01), Aix75(r=0.50, p<0.01), DAI(r=0.50 p<0.01) and DRA (r=0.55 p<0.001). Additionally a reduced resting coronary flow velocity time integral, a marker of coronary flow was related with reduced DAI% and DRA (r=0.36, r=0.38 p<0.05). Patients with CFR<2.5 had higher PWVc (11.6± 2.3 vs. 10.2±1.4, p< 0.05) PWVa (10.5± 2.3 vs. 9.2± 1.4, p< 0.05), SBPc (141± 20 vs. 123±19, p< 0.01), Aix (36± 16 vs. 29.2± 16, p< 0.05) and lower RT (106±21 vs. 123±20, p<0.05), DAI (48±9 vs. 51±6, p<0.05) and DRA (42±8 vs. 51±12, p<0.05). compared with those with CFR>2.5 (p < 0.05). By ROC analysis, an PWVa > 10 m/sec, SBPc>130 mmHg, RT <120ms, AI <32% and DRA<50 was found to have a sensitivity of 70 %,75%,76%, 70%, and 84% and a specificity of 60%, 72%, 67%, 63%, and 64% respectively to identify patients with CFR<2.5.Conclusions: Abnormal wall properties and wave reflection are related with impaired resting coronary flow and coronary flow reserve after revascularisation suggesting a role for pulse wave analysis as a noninvasive test to identify CAD patients with impaired coronary perfusion and thus adverse prognosis despite successful revascularisation.