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Coronary flow reserve in patients with aortic stenosis and nonobstructed coronary arteries

Marko D Banovic1, Bosiljka D Vujisic-Tesic, Vuk G Kujacic

  • 1Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia. markobanovic71@gmail.com

Acta Cardiologica
|February 4, 2012
PubMed

Insights

Aortic valve resistance (AVR) best predicts impaired coronary flow velocity reserve (CFVR) in patients with aortic stenosis (AS) and no coronary artery disease. This finding aids in assessing cardiovascular event risk in AS patients.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Medical Imaging

Background:

  • Patients with moderate to severe aortic stenosis (AS) and clear coronary arteries often exhibit impaired coronary flow velocity reserve (CFVR).
  • CFVR is a significant independent predictor of future cardiovascular events in AS patients.

Purpose of the Study:

  • To identify which factors, including left ventricular (LV) mass, wall thickness, diastolic dysfunction, LV workload, and hemodynamic indices of AS severity, most significantly contribute to impaired CFVR.
  • To determine the primary determinant of impaired CFVR in AS patients without obstructive epicardial coronary disease.

Main Methods:

  • A prospective study involving 77 patients with moderate or severe AS and nonobstructed coronary angiograms.
  • Standard Doppler-echocardiography, coronary angiography, and adenosine-stress transthoracic Doppler-echocardiography for CFVR measurement were performed.
  • Univariate and multivariate analyses were used to assess associations between various parameters and impaired CFVR, with receiver operating characteristic (ROC) analysis to determine predictive accuracy.

Main Results:

  • Univariate analysis indicated 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 with impaired CFVR (P ≤ 0.05).
  • Multivariate analysis identified AVR as the strongest predictor of impaired CFVR (RR 0.900, P = 0.007).
  • ROC analysis revealed an AVR value of 211.22 dynes x s x cm(-5) as the most accurate predictor of impaired CFVR (AUC = 0.681, P = 0.007).

Conclusions:

  • Hemodynamic indices of AS severity and LV workload parameters are key determinants of CFVR in AS patients.
  • Aortic valve resistance (AVR) emerges as the most potent predictor of impaired CFVR in patients with moderate or severe AS and unobstructed coronary arteries.
Abstract

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