Pathophysiological coronary and microcirculatory flow alterations in aortic stenosis

Area of Science:

• Cardiology
• Physiology

Background:

• Coronary blood flow regulation involves ventriculoarterial and neurohumoral mechanisms.
• Aortic valve integrity is crucial for maintaining coronary blood flow.
• Aortic stenosis (AS) is the most prevalent valvular heart disease, with increasing incidence due to population aging.

Purpose of the Study:

• To review the pathophysiology of coronary blood flow in patients with aortic stenosis.
• To discuss the impact of AS on coronary physiology and myocardial ischemia.
• To highlight challenges in assessing coronary artery disease in AS patients.

Main Methods:

• Review of contemporary basic science.
• Analysis of data from animal studies.
• Examination of human study data.

Main Results:

• Aortic stenosis triggers structural, microcirculatory, and neurohumoral changes.
• These changes impair coronary flow reserve and cause myocardial ischemia, independent of coronary stenosis.
• Interventions for severe AS may normalize coronary physiology, but require adaptation.

Conclusions:

• Aortic stenosis significantly disrupts coronary blood flow and myocardial function.
• Physiological assessment of coronary artery disease in AS patients presents unique challenges.
• Further validation of invasive physiological measures in AS is needed.