Cargando…

Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation

AIMS: In patients with aortic stenosis (AS), the coronary flow reserve decreases even in the absence of epicardial coronary artery stenosis. Systolic coronary flow reversal (SFR) reflecting reduced coronary microcirculation, often seen in patients with severe AS, has a potential negative impact on t...

Descripción completa

Detalles Bibliográficos
Autores principales: Suzuki, Wataru, Nakano, Yusuke, Ando, Hirohiko, Fujimoto, Masanobu, Sakurai, Hikaru, Suzuki, Mayu, Takahashi, Hiroshi, Mukai, Kentaro, Amano, Tetsuya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10192257/
https://www.ncbi.nlm.nih.gov/pubmed/37057311
http://dx.doi.org/10.1002/ehf2.14316
_version_ 1785043589622923264
author Suzuki, Wataru
Nakano, Yusuke
Ando, Hirohiko
Fujimoto, Masanobu
Sakurai, Hikaru
Suzuki, Mayu
Takahashi, Hiroshi
Mukai, Kentaro
Amano, Tetsuya
author_facet Suzuki, Wataru
Nakano, Yusuke
Ando, Hirohiko
Fujimoto, Masanobu
Sakurai, Hikaru
Suzuki, Mayu
Takahashi, Hiroshi
Mukai, Kentaro
Amano, Tetsuya
author_sort Suzuki, Wataru
collection PubMed
description AIMS: In patients with aortic stenosis (AS), the coronary flow reserve decreases even in the absence of epicardial coronary artery stenosis. Systolic coronary flow reversal (SFR) reflecting reduced coronary microcirculation, often seen in patients with severe AS, has a potential negative impact on the pathogenesis of cardiac dysfunction. However, there are limited data on the relationship between the severity of AS and SFR, as well as on the benefits of transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the relationship between the severity of AS and efficacy of TAVI in improving SFR. METHODS AND RESULTS: Consecutive patients with AS who had undergone TAVI using transoesophageal echocardiography (TEE) from November 2020 to February 2022 were prospectively enrolled. Coronary flow in the left anterior descending artery as well as the aortic valve peak velocities, and the mean aortic valve pressure gradients (AVPGs), indicating the severity of AS, were measured using intraprocedural TEE before and after TAVI. The following parameters were measured as coronary flow: systolic and diastolic peak velocity (cm/s) and systolic and diastolic velocity‐time integral (VTI) (cm). SFR was defined as the presence of a reversal coronary flow component in systole. The enrolled patients were classified into two groups according to the presence or absence of SFR before TAVI. A total of 25 patients were included: 13 had SFR and 12 who had no SFR, before TAVI. Patients with SFR had significantly higher aortic valve peak velocities (451.1 ± 45.9 vs. 372.1 ± 52.1 cm/s; P < 0.001) and mean AVPGs (49.2 ± 14.5 vs. 30.3 ± 11.6 mmHg; P = 0.002) than those without. The optimal binary cut‐off aortic valve peak velocity values and the mean AVPG associated with the presence of SFR before TAVI were >410.0 cm/s (specificity, 75.0%; sensitivity, 92.3%) and >37.4 mmHg (specificity, 83.3%; sensitivity, 92.3%), respectively. After TAVI, SFR immediately disappeared in 11 of 13 patients with SFR (84.6%). Overall, the systolic coronary VTI significantly increased after TAVI (2.0 ± 4.7 vs. 6.4 ± 3.2 cm, P < 0.001), and this increase was greater in patients with SFR than in those without SFR before TAVI (interaction P = 0.035). CONCLUSIONS: SFR was found to be associated with the severity of AS and with a greater increase in systolic coronary flow immediately after TAVI.
format Online
Article
Text
id pubmed-10192257
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-101922572023-05-19 Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation Suzuki, Wataru Nakano, Yusuke Ando, Hirohiko Fujimoto, Masanobu Sakurai, Hikaru Suzuki, Mayu Takahashi, Hiroshi Mukai, Kentaro Amano, Tetsuya ESC Heart Fail Original Articles AIMS: In patients with aortic stenosis (AS), the coronary flow reserve decreases even in the absence of epicardial coronary artery stenosis. Systolic coronary flow reversal (SFR) reflecting reduced coronary microcirculation, often seen in patients with severe AS, has a potential negative impact on the pathogenesis of cardiac dysfunction. However, there are limited data on the relationship between the severity of AS and SFR, as well as on the benefits of transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the relationship between the severity of AS and efficacy of TAVI in improving SFR. METHODS AND RESULTS: Consecutive patients with AS who had undergone TAVI using transoesophageal echocardiography (TEE) from November 2020 to February 2022 were prospectively enrolled. Coronary flow in the left anterior descending artery as well as the aortic valve peak velocities, and the mean aortic valve pressure gradients (AVPGs), indicating the severity of AS, were measured using intraprocedural TEE before and after TAVI. The following parameters were measured as coronary flow: systolic and diastolic peak velocity (cm/s) and systolic and diastolic velocity‐time integral (VTI) (cm). SFR was defined as the presence of a reversal coronary flow component in systole. The enrolled patients were classified into two groups according to the presence or absence of SFR before TAVI. A total of 25 patients were included: 13 had SFR and 12 who had no SFR, before TAVI. Patients with SFR had significantly higher aortic valve peak velocities (451.1 ± 45.9 vs. 372.1 ± 52.1 cm/s; P < 0.001) and mean AVPGs (49.2 ± 14.5 vs. 30.3 ± 11.6 mmHg; P = 0.002) than those without. The optimal binary cut‐off aortic valve peak velocity values and the mean AVPG associated with the presence of SFR before TAVI were >410.0 cm/s (specificity, 75.0%; sensitivity, 92.3%) and >37.4 mmHg (specificity, 83.3%; sensitivity, 92.3%), respectively. After TAVI, SFR immediately disappeared in 11 of 13 patients with SFR (84.6%). Overall, the systolic coronary VTI significantly increased after TAVI (2.0 ± 4.7 vs. 6.4 ± 3.2 cm, P < 0.001), and this increase was greater in patients with SFR than in those without SFR before TAVI (interaction P = 0.035). CONCLUSIONS: SFR was found to be associated with the severity of AS and with a greater increase in systolic coronary flow immediately after TAVI. John Wiley and Sons Inc. 2023-04-13 /pmc/articles/PMC10192257/ /pubmed/37057311 http://dx.doi.org/10.1002/ehf2.14316 Text en © 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Suzuki, Wataru
Nakano, Yusuke
Ando, Hirohiko
Fujimoto, Masanobu
Sakurai, Hikaru
Suzuki, Mayu
Takahashi, Hiroshi
Mukai, Kentaro
Amano, Tetsuya
Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation
title Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation
title_full Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation
title_fullStr Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation
title_full_unstemmed Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation
title_short Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation
title_sort association between coronary flow and aortic stenosis during transcatheter aortic valve implantation
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10192257/
https://www.ncbi.nlm.nih.gov/pubmed/37057311
http://dx.doi.org/10.1002/ehf2.14316
work_keys_str_mv AT suzukiwataru associationbetweencoronaryflowandaorticstenosisduringtranscatheteraorticvalveimplantation
AT nakanoyusuke associationbetweencoronaryflowandaorticstenosisduringtranscatheteraorticvalveimplantation
AT andohirohiko associationbetweencoronaryflowandaorticstenosisduringtranscatheteraorticvalveimplantation
AT fujimotomasanobu associationbetweencoronaryflowandaorticstenosisduringtranscatheteraorticvalveimplantation
AT sakuraihikaru associationbetweencoronaryflowandaorticstenosisduringtranscatheteraorticvalveimplantation
AT suzukimayu associationbetweencoronaryflowandaorticstenosisduringtranscatheteraorticvalveimplantation
AT takahashihiroshi associationbetweencoronaryflowandaorticstenosisduringtranscatheteraorticvalveimplantation
AT mukaikentaro associationbetweencoronaryflowandaorticstenosisduringtranscatheteraorticvalveimplantation
AT amanotetsuya associationbetweencoronaryflowandaorticstenosisduringtranscatheteraorticvalveimplantation