PT  - JOURNAL ARTICLE
AU  - Scarsini, Roberto
AU  - Portolan, Leonardo
AU  - Della Mora, Francesco
AU  - Fabroni, Margherita
AU  - Andreaggi, Stefano
AU  - Mainardi, Andrea
AU  - Springhetti, Paolo
AU  - Dotto, Alberto
AU  - Del Sole, Paolo Alberto
AU  - Fezzi, Simone
AU  - Pazzi, Sara
AU  - Tavella, Domenico
AU  - Mammone, Concetta
AU  - Lunardi, Mattia
AU  - Pesarini, Gabriele
AU  - Benfari, Giovanni
AU  - Ribichini, Flavio Luciano
TI  - Coronary microvascular dysfunction in patients undergoing transcatheter aortic valve implantation
AID  - 10.1136/heartjnl-2023-323461
DP  - 2024 Apr 01
TA  - Heart
PG  - 603--612
VI  - 110
IP  - 8
4099  - http://heart.bmj.com/content/110/8/603.short
4100  - http://heart.bmj.com/content/110/8/603.full
SO  - Heart2024 Apr 01; 110
AB  - 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.Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.