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Microcirculatory Function in Nonhypertrophic and Hypertrophic Myocardium in Patients With Aortic Valve Stenosis

Muhammad Sabbah1, Niels Thue Olsen2,3, Mikko Minkkinen1

  • 1Department of Cardiology Copenhagen University Hospital-Rigshospitalet Copenhagen Denmark.

Journal of the American Heart Association
|April 26, 2022
PubMed

Insights

Patients with left ventricular hypertrophy (LVH) from severe aortic stenosis show reduced myocardial blood flow and increased resistance. This highlights impaired coronary microcirculation in LVH patients.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Medical Imaging

Background:

  • Left ventricular hypertrophy (LVH) is often linked to abnormal myocardial blood flow and resistance.
  • Severe aortic stenosis can cause LVH, potentially affecting coronary circulation.

Purpose of the Study:

  • To quantify physiological and pathological changes in myocardial blood flow and microcirculatory resistance.
  • To compare these parameters in patients with and without LVH due to severe aortic stenosis.

Main Methods:

  • Utilized continuous thermodilution and saline infusion for absolute coronary blood flow and microvascular resistance measurements.
  • Assessed myocardial mass using cardiac magnetic resonance imaging.
  • Enrolled 53 patients with severe aortic valve stenosis.

Main Results:

  • Patients with LVH (n=32) exhibited significantly decreased hyperemic blood flow per gram of tissue compared to those without LVH (n=21) (1.26±0.48 vs. 1.66±0.65 mL·min⁻¹·g⁻¹; P=0.018).
  • Minimal resistance indexed for left ventricular mass was significantly higher in patients with LVH (63 [47-82] vs. 43 [35-63] Wood Units·kg; P=0.014).

Conclusions:

  • LVH in severe aortic stenosis is associated with reduced myocardial hyperemic blood flow.
  • Patients with LVH due to severe aortic stenosis demonstrate increased minimal myocardial resistance, indicating impaired coronary microcirculation.

Keywords:
aortic stenosiscardiac magnetic resonance imagingcoronary flowleft ventricular hypertrophymicrovascular functionthermodilution

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