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[Transesophageal coronary flowmetry and ventricular diastolic properties in surgically treated aortic insufficiency]
G Tamborini1, P Barbier, E Doria
1Istituto di Cardiologia, Università degli Studi, Milano.
Insights
Severe aortic regurgitation (AR) impairs coronary flow (CF) and diastolic function due to reduced coronary perfusion pressure (CPP). Aortic valve replacement normalizes CPP and CF patterns, improving diastolic function.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Echocardiography
Background:
- Aortic regurgitation (AR) can cause anginal pain due to impaired coronary flow (CF) reserve and reduced diastolic CF, linked to diminished coronary perfusion pressure (CPP).
- Understanding the impact of AR on coronary circulation and diastolic function is crucial for managing patients with this condition.
Purpose of the Study:
- To evaluate the coronary flow (CF) pattern in patients with severe aortic regurgitation (AR) before and after aortic valve replacement (AVR).
- To correlate CF patterns with hemodynamic parameters of left ventricular systolic and diastolic function.
- To compare CF patterns in AR patients with a healthy control group.
Main Methods:
- Transesophageal multiplane echocardiography was used to assess CF patterns in 15 severe AR patients and 10 controls.
- Coronary flow was analyzed into systolic (S), protodiastolic (PD), and end-diastolic (ED) components.
- Correlation with left ventricular function (fractional shortening, E/A ratio, pulmonary venous flow) and pulmonary wedge pressure was performed.
Main Results:
- Patients with AR showed a reduced diastolic/systolic (D/S) CF ratio and an increased protodiastolic/end-diastolic (PD/ED) CF ratio compared to controls.
- The increased PD/ED ratio correlated positively with left ventricular diastolic impairment and negatively with CPP.
- Following AVR, improved diastolic function and increased CPP were associated with normalization of the CF pattern.
Conclusions:
- In AR, diastolic dysfunction and abnormal CPP are closely linked to reduced diastolic coronary flow.
- Aortic valve replacement effectively normalizes CPP and diastolic function, leading to improved coronary flow patterns in late diastole.
Abstract:
In patients with aortic valve regurgitation anginal pain without coronary artery disease is a consequence of both impairment of coronary flow (CF) reserve and reduction of diastolic CF (D) due to a diminished coronary perfusion pressure (CPP). Aim of this study was to evaluate with transesophageal multiplane echocardiography CF pattern in 15 patients with severe aortic regurgitation (AR) in the operative room before and after aortic valve replacement and to correlate it with hemodynamic parameters of left ventricular systolic (echocardiographic fractional shortening area) and diastolic (Doppler E/A ratio of mitral flow and X/Y ratio of pulmonary venous flow; pulmonary wedge pressure) function. Patients were compared to a control group (C) of 10 subjects. Coronary flow was divided into systolic (S), protodiastolic (PD) and end-diastolic (ED) components. In AR we observed a reduction in D/S ratio (2.6 +/- 1.3 versus 3.5 +/- 0.8, NS) and an increase in PD/ED ratio (2.24 +/- 2.8 versus 1.05 +/- 0.15, p < 0.001). A positive correlation was observed between PD/ED ratio and left ventricular diastolic impairment (E/A ratio: r = 0.71, p < 0.001; wedge pressure: r = 0.70, p < 0.001) and a negative correlation with CPP (r = -0.6, p < 0.02). Forty-five min after aortic valve replacement diastolic function improvement and CPP increase were associated with a normalization of CF pattern (D/S = 4.35 +/- 1.9/PD/ED = 1.06 +/- 0.16). In conclusion in AR diastolic dysfunction and abnormal CPP are strictly related to the reduction in diastolic CF; valve replacement normalizes the former two parameters and redistributes CF in late diastole.