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Myocardial Blood Flow Reserve, Microvascular Coronary Health, and Myocardial Remodeling in Patients With Aortic Stenosis
Journal article   Open access   Peer reviewed

Myocardial Blood Flow Reserve, Microvascular Coronary Health, and Myocardial Remodeling in Patients With Aortic Stenosis

Fares Alahdab, Ahmed I Ahmed, Malek Nayfeh, Yushui Han, Ola Abdelkarim, Moath S Alfawara, Stephen H Little, Michael J Reardon, Nadeen N Faza, Sachin S Goel, …
Journal of the American Heart Association, Vol.13(11), p.e033447
06/04/2024
DOI: 10.1161/JAHA.123.033447
PMCID: PMC11255635
PMID: 38780160
url
https://doi.org/10.1161/JAHA.123.033447View
Published (Version of record) Open Access

Abstract

Coronary microvascular function and hemodynamics may play a role in coronary circulation and myocardial remodeling in patients with aortic stenosis (AS). We aimed to evaluate the relationship between myocardial blood flow and myocardial function in patients with AS, no AS, and aortic valve sclerosis. We included consecutive patients who had resting transthoracic echocardiography and clinically indicated positron emission tomography myocardial perfusion imaging to capture their left ventricular ejection fraction, global longitudinal strain (GLS), and myocardial flow reserve (MFR). The primary outcome was major adverse cardiovascular event (all-cause mortality, myocardial infarction, or late revascularization). There were 2778 patients (208 with aortic sclerosis, 39 with prosthetic aortic valve, 2406 with no AS, and 54, 49, and 22 with mild, moderate, and severe AS, respectively). Increasing AS severity was associated with impaired MFR ( <0.001) and GLS ( <0.001), even when perfusion was normal. Statistically significant associations were noted between MFR and GLS, MFR and left ventricular ejection fraction, and MFR and left ventricular ejection fraction reserve. After a median follow-up of 349 (interquartile range, 116-662) days, 4 (7.4%), 5 (10.2%), and 6 (27.3%) patients experienced a major adverse cardiovascular event in the mild, moderate, and severe AS groups, respectively. In a matched-control analysis, patients with mild-to-moderate AS had higher rates of impaired MFR (52.9% versus 39.9%; =0.048) and major adverse cardiovascular event (11.8% versus 3.0%; =0.002). Despite lack of ischemia, as severity of AS increased, MFR decreased and GLS worsened, reflecting worse coronary microvascular health and myocardial remodeling. Positron emission tomography-derived MFR showed a significant independent correlation with left ventricular ejection fraction and GLS. Patients with prosthetic aortic valve showed a high prevalence of impaired MFR.
 Aged Aged, 80 and over Aortic Valve - diagnostic imaging Aortic Valve - physiopathology Aortic Valve - surgery Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - physiopathology Coronary Circulation - physiology Echocardiography Female Fractional Flow Reserve, Myocardial - physiology Humans Male Microcirculation - physiology Middle Aged Myocardial Perfusion Imaging - methods Retrospective Studies Severity of Illness Index Stroke Volume - physiology Ventricular Function, Left - physiology Ventricular Remodeling - physiology

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