Why the study?
The cause for the association between increased cardiovascular mortality rates and lower BP after AVR is unclear.
Does lowering blood pressure reduce epicardial coronary flow to ischemic levels in a post-AVR simulator model with a right coronary lesion?
Does lowering blood pressure reduce epicardial coronary flow to ischemic levels in a post-AVR simulator model with a right coronary lesion?
In a simulated post-AVR model with a right coronary lesion, lowering diastolic blood pressure did not reduce the flow ratio index to ischemic thresholds, though the authors suggest reconsidering BP targets in this population.
Background: The cause for the association between increased cardiovascular mortality rates and lower blood pressure (BP) after aortic valve replacement (AVR) is unclear. This study aims to assess how the epicardial coronary flow (ECF) after AVR varies as BP levels are changed in the presence of a right coronary lesion. Methods: left heart simulator under a range of varying systolic blood pressure (SBP) and diastolic blood pressure (DBP). ECF and the flow ratio index were calculated. Flow index value <0.8 was considered a threshold for ischemia. Results: ≤ 0.0055). With decreasing DBP, no BP condition yielded a flow ratio index that was less than 0.91. Conclusions: Reducing BP to the current recommended levels assigned for the general population after AVR in the presence of coronary artery disease may require reconsideration of levels and treatment priority. Additional studies are needed to fully understand the changes in ECF dynamics after AVR in the presence and absence of coronary artery disease.
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Vogl et al. (2023) studied this question.
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