RT Journal Article
SR Electronic
T1 Coronary microvascular dysfunction in patients undergoing transcatheter aortic valve implantation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 603
OP 612
DO 10.1136/heartjnl-2023-323461
VO 110
IS 8
A1 Scarsini, Roberto
A1 Portolan, Leonardo
A1 Della Mora, Francesco
A1 Fabroni, Margherita
A1 Andreaggi, Stefano
A1 Mainardi, Andrea
A1 Springhetti, Paolo
A1 Dotto, Alberto
A1 Del Sole, Paolo Alberto
A1 Fezzi, Simone
A1 Pazzi, Sara
A1 Tavella, Domenico
A1 Mammone, Concetta
A1 Lunardi, Mattia
A1 Pesarini, Gabriele
A1 Benfari, Giovanni
A1 Ribichini, Flavio Luciano
YR 2024
UL http://heart.bmj.com/content/110/8/603.abstract
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.