RT Journal Article
SR Electronic
T1 Absolute coronary flow and microvascular resistance reserve in patients with severe aortic stenosis
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 47
OP 54
DO 10.1136/heartjnl-2022-321348
VO 109
IS 1
A1 Pasquale Paolisso
A1 Emanuele Gallinoro
A1 Marc Vanderheyden
A1 Giuseppe Esposito
A1 Dario Tino Bertolone
A1 Marta Belmonte
A1 Niya Mileva
A1 Konstantinos Bermpeis
A1 Cristina De Colle
A1 Davide Fabbricatore
A1 Alessandro Candreva
A1 Daniel Munhoz
A1 Ivan Degrieck
A1 Filip Casselman
A1 Martin Penicka
A1 Carlos Collet
A1 Jeroen Sonck
A1 Fabio Mangiacapra
A1 Bernard de Bruyne
A1 Emanuele Barbato
YR 2023
UL http://heart.bmj.com/content/109/1/47.abstract
AB Background Development of left ventricle (LV) hypertrophy in aortic stenosis (AS) is accompanied by adaptive coronary flow regulation. We aimed to assess absolute coronary flow, microvascular resistance, coronary flow reverse (CFR) and microvascular resistance reserve (MRR) in patients with and without AS.Methods Absolute coronary flow and microvascular resistance were measured by continuous thermodilution in 29 patients with AS and 29 controls, without AS, matched for age, gender, diabetes and functional severity of epicardial coronary lesions. Myocardial work, total myocardial mass and left anterior descending artery (LAD)-specific mass were quantified by echocardiography and cardiac-CT.Results Patients with AS presented a significantly positive LV remodelling with lower global longitudinal strain and global work efficacy compared with controls. Total LV myocardial mass and LAD-specific myocardial mass were significantly higher in patients with AS (p=0.001). Compared with matched controls, absolute resting flow in the LAD was significantly higher in the AS cohort (p=0.009), resulting into lower CFR and MRR in the AS cohort compared with controls (p<0.005 for both). No differences were found in hyperaemic flow and resting and hyperaemic resistances. Hyperaemic myocardial perfusion (calculated as the ratio between the absolute coronary flow subtended to the LAD, expressed in mL/min/g), but not resting, was significantly lower in the AS group (p=0.035).Conclusions In patients with severe AS and non-obstructive coronary artery disease, with the progression of LV hypertrophy, the compensatory mechanism of increased resting flow maintains adequate perfusion at rest, but not during hyperaemia. As a consequence, both CFR and MRR are significantly impaired.Data are available on reasonable request.