Transcatheter aortic valve implantation immediately increased hyperemic flow velocity from 46.24 to 56.56 cm/s and improved coronary vasodilatory reserve in patients without aortic regurgitation.
Observational (n=55)
No
Does TAVI immediately improve coronary hemodynamics and microvascular function in patients with aortic valve stenosis?
TAVI induces an immediate improvement in coronary vasodilatory reserve and hyperemic flow velocity in patients with aortic stenosis, particularly when post-procedural aortic regurgitation is absent.
Tasa de eventos absoluta: 56.56% vs 46.24%
valor p: p=0.003
BACKGROUND: Aortic valve stenosis (AS) induces compensatory alterations in left ventricular hemodynamics, leading to physiological and pathological alterations in coronary hemodynamics. Relief of AS by transcatheter aortic valve implantation (TAVI) decreases ventricular afterload and is expected to improve microvascular function immediately. We evaluated the effect of AS on coronary hemodynamics and the immediate effect of TAVI. METHODS AND RESULTS: Intracoronary pressure and flow velocity were simultaneously assessed at rest and at maximal hyperemia in an unobstructed coronary artery in 27 patients with AS before and immediately after TAVI and in 28 patients without AS. Baseline flow velocity was higher and baseline microvascular resistance was lower in patients with AS as compared with controls, which remained unaltered post-TAVI. In patients with AS, hyperemic flow velocity was significantly lower as compared with controls (44.5±14.5 versus 54.3±18.6 cm/s; P=0.04). Hyperemic microvascular resistance (expressed in mm Hg·cm·s(-1)) was 2.10±0.69 in patients with AS as compared with 1.80±0.60 in controls (P=0.096). Coronary flow velocity reserve in patients with AS was lower, 1.9±0.5 versus 2.7±0.7 in controls (P<0.001). Improvement in coronary hemodynamics after TAVI was most pronounced in patients without post-TAVI aortic regurgitation. In these patients (n=20), hyperemic flow velocity increased significantly from 46.24±15.47 pre-TAVI to 56.56±17.44 cm/s post-TAVI (P=0.003). Hyperemic microvascular resistance decreased from 2.03±0.71 to 1.66±0.45 (P=0.050). Coronary flow velocity reserve increased significantly from 1.9±0.4 to 2.2±0.6 (P=0.009). CONCLUSIONS: The vasodilatory reserve capacity of the coronary circulation is reduced in AS. TAVI induces an immediate decrease in hyperemic microvascular resistance and a concomitant increase in hyperemic flow velocity, resulting in immediate improvement in coronary vasodilatory reserve.
Wiegerinck et al. (Sat,) conducted a observational in Aortic valve stenosis (n=55). Transcatheter Aortic Valve Implantation (TAVI) vs. Pre-TAVI baseline and patients without aortic valve stenosis was evaluated on Hyperemic flow velocity (cm/s) in patients without post-TAVI aortic regurgitation (p=0.003). Transcatheter aortic valve implantation immediately increased hyperemic flow velocity from 46.24 to 56.56 cm/s and improved coronary vasodilatory reserve in patients without aortic regurgitation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: