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Background The coronary flow reserve (CFR), defined as the ratio of maximal drug-induced hyperemic to basal coronary flow, represents the functional significant of coronary stenosis.The aim of the study was to assess the diagnostic accuracy of CFR measured by transthoracic Doppler echocardiography (TTDE) associated with adenosine triphosphate (ATP) stress for detecting significant coronary stenosis in patients with chest pain.