Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow.
Aged
Aged, 80 and over
Aortic Valve
/ physiopathology
Aortic Valve Stenosis
/ diagnosis
Blood Flow Velocity
Cardiac Catheterization
Coronary Artery Disease
/ diagnosis
Coronary Circulation
Coronary Stenosis
/ diagnosis
Coronary Vessels
/ physiopathology
Europe
Female
Hemodynamics
Humans
Male
Microcirculation
Percutaneous Coronary Intervention
Predictive Value of Tests
Recovery of Function
Severity of Illness Index
Transcatheter Aortic Valve Replacement
Treatment Outcome
aortic valve stenosis
diastole
hyperemia
microcirculation
myocardium
Journal
Circulation. Cardiovascular interventions
ISSN: 1941-7632
Titre abrégé: Circ Cardiovasc Interv
Pays: United States
ID NLM: 101499602
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
entrez:
23
11
2019
pubmed:
23
11
2019
medline:
28
7
2020
Statut:
ppublish
Résumé
Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation. Group 1: 55 patients with severe AS and intermediate coronary stenoses treated with transcatheter aortic valve implantation (TAVI) were included. Group 2: 85 patients with intermediate coronary stenoses and no AS treated with percutaneous coronary intervention were included. Coronary pressure and flow were measured at rest and during hyperemia in both groups, before and after TAVI (group 1) and before and after percutaneous coronary intervention (group 2). Microvascular resistance over the wave-free period of diastole increased significantly post-TAVI (pre-TAVI, 2.71±1.4 mm Hg·cm·s TAVI improves microcirculatory function regardless of the severity of underlying coronary disease. TAVI for severe AS produces a coronary hemodynamic improvement equivalent to the hemodynamic benefit of stenting coronary stenoses with instantaneous wave-free ratio values <0.74. Future trials of physiology-guided revascularization in severe AS may consider using this value to guide treatment of concomitant coronary artery disease.
Sections du résumé
BACKGROUND
Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation.
METHODS
Group 1: 55 patients with severe AS and intermediate coronary stenoses treated with transcatheter aortic valve implantation (TAVI) were included. Group 2: 85 patients with intermediate coronary stenoses and no AS treated with percutaneous coronary intervention were included. Coronary pressure and flow were measured at rest and during hyperemia in both groups, before and after TAVI (group 1) and before and after percutaneous coronary intervention (group 2).
RESULTS
Microvascular resistance over the wave-free period of diastole increased significantly post-TAVI (pre-TAVI, 2.71±1.4 mm Hg·cm·s
CONCLUSIONS
TAVI improves microcirculatory function regardless of the severity of underlying coronary disease. TAVI for severe AS produces a coronary hemodynamic improvement equivalent to the hemodynamic benefit of stenting coronary stenoses with instantaneous wave-free ratio values <0.74. Future trials of physiology-guided revascularization in severe AS may consider using this value to guide treatment of concomitant coronary artery disease.
Identifiants
pubmed: 31752515
doi: 10.1161/CIRCINTERVENTIONS.119.008263
pmc: PMC6924937
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e008263Subventions
Organisme : Medical Research Council
ID : MR/M018369/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : G1000357
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/11/46/28861
Pays : United Kingdom
Organisme : Wellcome Trust
ID : PS3162_WHCP
Pays : United Kingdom
Organisme : Medical Research Council
ID : G1100443
Pays : United Kingdom
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