Coronary microvascular dysfunction, left ventricular remodeling, and clinical outcomes in aortic stenosis.
PET
echo
modalities
myocardial blood flow
tests
Journal
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
ISSN: 1532-6551
Titre abrégé: J Nucl Cardiol
Pays: United States
ID NLM: 9423534
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
12
02
2019
accepted:
25
03
2019
pubmed:
3
5
2019
medline:
1
2
2022
entrez:
3
5
2019
Statut:
ppublish
Résumé
We investigated role of coronary microvascular disease (CMD) in maladaptive LV remodeling and prognosis in patients with aortic sclerosis or stenosis and no overt CAD. This was a retrospective cohort study of patients with aortic sclerosis or stenosis, normal myocardial perfusion and LV ejection fraction (EF) > 50% (n = 43) and matched controls without AS (n = 43). PET and echocardiograms were performed within 1 year of each other. Myocardial perfusion and myocardial flow reserve (MFR) were quantified using PET imaging. LV structure and function, including global longitudinal strain (GLS), were quantified by transthoracic echocardiography. Global MFR declined with increasing AS severity (P = 0.04). Probability of impaired MFR increased with severity of adverse LV remodeling (OR 1.88, CI 1.03 to 3.41, P =0.04). Reduced MFR associated with impaired GLS (r = - 0.29, P = 0.002) and associated with reduced MACE-free survival at 7.27 years median follow-up. Adjusted annualized rate of MACE was highest in those with impaired GLS and MFR and lowest in those with normal GLS and MFR (30.99% vs 1.86%, P =0.002). In patients with AS and no overt CAD, impaired MFR associates with adverse LV remodeling and subclinical LV mechanical dysfunction, and is a marker increased clinical risk.
Sections du résumé
BACKGROUND
BACKGROUND
We investigated role of coronary microvascular disease (CMD) in maladaptive LV remodeling and prognosis in patients with aortic sclerosis or stenosis and no overt CAD.
METHODS
METHODS
This was a retrospective cohort study of patients with aortic sclerosis or stenosis, normal myocardial perfusion and LV ejection fraction (EF) > 50% (n = 43) and matched controls without AS (n = 43). PET and echocardiograms were performed within 1 year of each other. Myocardial perfusion and myocardial flow reserve (MFR) were quantified using PET imaging. LV structure and function, including global longitudinal strain (GLS), were quantified by transthoracic echocardiography.
RESULTS
RESULTS
Global MFR declined with increasing AS severity (P = 0.04). Probability of impaired MFR increased with severity of adverse LV remodeling (OR 1.88, CI 1.03 to 3.41, P =0.04). Reduced MFR associated with impaired GLS (r = - 0.29, P = 0.002) and associated with reduced MACE-free survival at 7.27 years median follow-up. Adjusted annualized rate of MACE was highest in those with impaired GLS and MFR and lowest in those with normal GLS and MFR (30.99% vs 1.86%, P =0.002).
CONCLUSION AND RELEVANCE
CONCLUSIONS
In patients with AS and no overt CAD, impaired MFR associates with adverse LV remodeling and subclinical LV mechanical dysfunction, and is a marker increased clinical risk.
Identifiants
pubmed: 31044406
doi: 10.1007/s12350-019-01706-y
pii: 10.1007/s12350-019-01706-y
pmc: PMC6824970
mid: NIHMS1528353
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
579-588Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL135438
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL132021
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL094301
Pays : United States
Commentaires et corrections
Type : CommentIn
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