Article Text
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.
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- 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.
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.
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