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Valvular heart disease
Original research
Coronary microvascular dysfunction in patients undergoing transcatheter aortic valve implantation
  1. Roberto Scarsini1,2,
  2. Leonardo Portolan1,
  3. Francesco Della Mora1,
  4. Margherita Fabroni1,
  5. Stefano Andreaggi1,
  6. Andrea Mainardi1,
  7. Paolo Springhetti1,
  8. Alberto Dotto1,
  9. Paolo Alberto Del Sole1,
  10. Simone Fezzi1,
  11. Sara Pazzi1,
  12. Domenico Tavella1,2,
  13. Concetta Mammone1,2,
  14. Mattia Lunardi1,2,
  15. Gabriele Pesarini1,2,
  16. Giovanni Benfari1,
  17. Flavio Luciano Ribichini1,2
  1. 1 Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
  2. 2 Interventional Cardiology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
  1. Correspondence to Dr Roberto Scarsini, Department of Medicine, Division of Cardiology, University of Verona, Verona 37126, Italy; scarsini.roberto{at}gmail.com

Abstract

Objectives This study aimed to evaluate the prognostic value of coronary microvascular dysfunction (CMD) at long term after transcatheter aortic valve implantation (TAVI) and to explore its relationship with extravalvular cardiac damage (EVCD). Moreover, we sought to test the correlation between angiography-derived index of microcirculatory resistance (IMRangio) and invasive IMR in patients with aortic stenosis (AS).

Methods This was a retrospective analysis of the Verona Valvular Heart Disease Registry (Italy) including 250 patients (83 (80–86) years, 53% female) with severe AS who underwent TAVI between 2019 and 2021. IMRangio was calculated offline using a computational flow model applied to coronary angiography obtained during the TAVI workup. CMD was defined as IMRangio ≥30 units.

The primary endpoint was the composite of cardiovascular death and rehospitalisation for heart failure (HF). Advanced EVCD was defined as pulmonary circulation impairment, severe tricuspid regurgitation or right ventricular dysfunction.

The correlation between IMR and IMRangio was prospectively assessed in 31 patients undergoing TAVI.

Results The primary endpoint occurred in 28 (11.2%) patients at a median follow-up of 22 (IQR 12–30) months. Patients with CMD met the primary endpoint more frequently than those without CMD (22.9% vs 2.8%, p<0.0001). Patients with CMD were more frequently characterised by advanced EVCD (33 (31.4%) vs 27 (18.6%), p=0.024). CMD was an independent predictor of adverse outcomes (adjusted HR 6.672 (2.251 to 19.778), p=0.001) and provided incremental prognostic value compared with conventional clinical and imaging variables. IMRangio demonstrated fair correlation with IMR.

Conclusions CMD is an independent predictor of cardiovascular mortality and HF after TAVI.

  • Aortic Valve Stenosis
  • Coronary Artery Disease
  • Coronary Angiography
  • Transcatheter Aortic Valve Replacement

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

https://doi.org/10.1136/heartjnl-2023-323461

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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    Footnotes

    • RS and LP are joint first authors.

    • RS and LP contributed equally.

    • Contributors RS and LP equally contributed to this work. All the authors contributed significantly to the study by planning (RS, GB, FLR), conducting (RS, LP, FDM), reporting (RS, LP, FDM), conceptualising (RS, GB, FLR) and designing (RS, GB, FLR), acquiring (RS, SA, MF, AM, PS, AD, PADS, SP) or analysing and interpreting the data (RS, LP, SF, DT, CM, ML, GP, GB). RS acts as guarantor of the study, accepting full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.

    • Funding This study was partially funded by a research grant from Abbott Vascular (n.1333-12/2020).

    • Competing interests RS reports research grant from Abbott Vascular and speakers fee from Abbott. FLR reports research grant from Abbott Vascular and Philips. The other authors report no conflict of interest.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.