Key result
Aortic valve resistance was the strongest predictor of impaired coronary flow velocity reserve in patients with moderate or severe aortic stenosis (RR 0.900; 95% CI 0.983-0.997; P=0.007).
Observational (n=77)
Relative Risk: 0.9 (95% CI 0.983–0.997)
p-value: p=0.007
Aortic valve resistance is the strongest predictor of impaired coronary flow velocity reserve in patients with moderate or severe aortic stenosis and nonobstructed coronary arteries.
May flag coronary microvascular risk in aortic stenosis; hypothesis-generating and should not yet change practice.
OBJECTIVE: Patients with moderate and severe aortic stenosis (AS) and without obstructive epicardial coronary disease have been shown to have an impairment of coronary flow velocity reserve (CFVR). Recently, it has been shown that CFVR is an independent predictor for future cardiovascular events in AS patients. We investigated parameters representing left ventricular (LV) mass and wall thickness, diastolic dysfunction, LV workload and haemodynamic indexes of AS severity to determine which contributes the most to impaired CFVR in patients with AS and a nonobstructed coronary angiogram. METHOD AND RESULTS: A total of 77 patients with moderate or severe AS, mean age 65.66 +/- 11.02 y (57.14% males), were enrolled in this prospective study. All patients had standard Doppler-echo study, coronary angiography and adenosine-stress transthoracic Doppler-echo for CFVR measurement. We took 2.5 as a cut-off value for impaired CFVR. Univariate analysis showed that aortic valve area (AVA), maximal velocity (Vmax), mean pressure gradient (Pmean), energy loss index (ELI), aortic valve resistance (AVR) and stroke work loss (SWL) were associated (P = 0.05) with impaired CFVR. Multivariate analysis showed that AVR was the best predictor of impaired CFVR (RR 0.900, Cl: 0.983-0.997, P = 0.007). Using ROC analysis, the AVR value of 211.22 dynes x s x cm(-5) had the highest accuracy in predicting the impaired CFVR (AUC-0.681, P=0.007, sensitivity 72%, specificity 52%, CI: 0.561-0.800). CONCLUSION: Haemodynamic indices of AS severity, together with LV workload parameters, are the main determinants of CFVR. Among all parameters, AVR is the strongest predictor of CFVR in patients with moderate or severe AS and a nonobstructed coronary angiogram.
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Banović et al. (2011) conducted an observational in Moderate or severe aortic stenosis with nonobstructed coronary arteries (n=77). Aortic valve resistance (AVR) was evaluated on Impaired coronary flow velocity reserve (CFVR < 2.5) (RR 0.900, 95% CI 0.983-0.997, p=0.007). Aortic valve resistance was the strongest predictor of impaired coronary flow velocity reserve in patients with moderate or severe aortic stenosis (RR 0.900; 95% CI 0.983-0.997; P=0.007).
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