Key result
Aortic valve intervention immediately reduced the backward decompression wave from 9.7 to 5.1 x10^3 Wm-2s-1, with further physiological improvements accompanying left ventricular hypertrophy regression.
Why the study?
Does aortic valve intervention and subsequent left ventricular hypertrophy regression improve coronary hemodynamics in patients with severe aortic stenosis?
Cohort (n=15)
Yes
Does aortic valve intervention and subsequent left ventricular hypertrophy regression improve coronary hemodynamics in patients with severe aortic stenosis?
Aortic valve intervention for severe aortic stenosis provides immediate hemodynamic relief, while subsequent regression of left ventricular hypertrophy offers additive improvements in coronary microvascular efficiency.
Answers are grounded in this paper and cite their sources.
Aortic valve intervention may enhance coronary hemodynamics in severe aortic stenosis; leaves open additive benefits from left ventricular hypertrophy regression.
AIM: Severe aortic stenosis frequently involves the development of left ventricular hypertrophy (LVH) creating a dichotomous haemodynamic state within the coronary circulation. Whilst the increased force of ventricular contraction enhances its resultant relaxation and thus increases the distal diastolic coronary "suction" force, the presence of LVH has a potentially opposing effect on ventricular-coronary interplay. The aim of this study was to use non-invasive coronary wave intensity analysis (WIA) to separate and measure the sequential effects of outflow tract obstruction relief and then LVH regression following intervention for aortic stenosis. METHODS: Fifteen patients with unobstructed coronary arteries undergoing aortic valve intervention (11 surgical aortic valve replacement [SAVR], 4 TAVI) were successfully assessed before and after intervention, and at 6 and 12 months post-procedure. Coronary WIA was constructed from simultaneously acquired coronary flow from transthoracic echo and pressure from an oscillometric brachial cuff system. Accompanying this, the BDW fraction increased to 32.8 ± 7.2% at 6 months (P = 0.01 vs post-procedure) and 34.7 ± 6.7% at 12 months (P < 0.001 vs post-procedure). CONCLUSION: In aortic stenosis, both the outflow tract gradient and the presence of LVH impact significantly on coronary haemodynamics that cannot be appreciated by examining resting coronary flow rates alone. An immediate change in coronary wave intensity occurs following intervention with further effects appreciable with hypertrophy regression. The improvement in prognosis with treatment is likely to be attributable to both features.
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Broyd et al. (2018) conducted a cohort in Severe aortic stenosis (n=15). Aortic valve intervention (SAVR or TAVI) vs. Pre-intervention baseline was evaluated on Cumulative Backward Decompression Wave (BDW) immediately post-procedure (p=<0.01). Aortic valve intervention immediately reduced the backward decompression wave from 9.7 to 5.1 x10^3 Wm-2s-1, with further physiological improvements accompanying left ventricular hypertrophy regression.
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