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Coronary microcirculatory dysfunction in aortic stenosis: myocardial contrast echocardiography study
Shigeru Miyagawa1, Takafumi Masai, Hirotsugu Fukuda
1Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. miyagawa@surg1.med.osaka-u.ac.jp
Insights
Aortic stenosis (AS) causes reduced subendocardial blood flow. Aortic valve replacement (AVR) significantly improves and sustains this microcirculatory function long-term.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Physiology
Background:
- Aortic stenosis (AS) is associated with microcirculatory dysfunction.
- Quantitative myocardial contrast echocardiography (MCE) can assess myocardial perfusion.
Purpose of the Study:
- To quantify microcirculatory dysfunction in aortic stenosis (AS).
- To measure changes in transmural perfusion after aortic valve replacement (AVR).
Main Methods:
- Myocardial contrast echocardiography (MCE) was used to quantify myocardial blood flow in the subendocardium and subepicardium.
- 22 patients with AS were studied before, 2 weeks after, and 1 year after AVR.
- 10 healthy volunteers and 10 patients with mitral regurgitation served as controls.
Main Results:
- Pre-AVR, subendocardial blood flow was significantly lower in AS patients compared to controls.
- Subepicardial blood flow showed no significant difference between groups.
- Subendocardial blood flow improved significantly 2 weeks after AVR and was sustained at 1 year.
Conclusions:
- Patients with AS exhibit preoperative subendocardial hypoperfusion.
- Aortic valve replacement (AVR) effectively restores coronary microcirculatory function.
- The recovery of myocardial blood flow post-AVR is durable, persisting at least one year.
Background:
The aims of this study were to quantify the microcirculatory dysfunction in aortic stenosis (AS) and to measure the changes in transmural perfusion after aortic valve replacement (AVR), using quantitative myocardial contrast echocardiography.
Methods:
Myocardial contrast echocardiography was used to quantify the myocardial blood flow in both the subendocardium and subepicardium in 22 patients with AS (A group), before, 2 weeks after, and 1 year after AVR. Healthy volunteers (C group, n = 10) and patients with mitral regurgitation (M group, n = 10) were included as controls. Triggered myocardial contrast echocardiography was performed, and the endosystolic 1.5 harmonic images were recorded.
Results:
The myocardial contrast echocardiography study showed that, before AVR, the myocardial blood flow in the subendocardium was significantly lower in the A group than in the other groups (CI = -18.6 +/- 3.0 dB, -11.8 +/- 4.1 dB, and -12.7 +/- 4.1 dB, respectively, in A, M, and C groups; p < 0.05), whereas there was no significant difference in blood flow in the subepicardium. In the A group, the myocardial blood flow in the subendocardium was significantly improved 2 weeks after AVR (-13.1 +/- 3.5 dB after AVR), and this improvement was preserved 1 year after AVR.
Conclusions:
In patients with AS, the myocardial blood flow in the subendocardium declined preoperatively, and the coronary microcirculatory function was recovered after AVR in both the short and long term.
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