Coronary blood flow in patients with severe aortic stenosis before and after transcatheter aortic valve implantation.

MedStar author(s):
Citation: American Journal of Cardiology. 114(8):1264-8, 2014 Oct 15.PMID: 25173443Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis/pp [Physiopathology] | *Cardiac Catheterization | *Coronary Circulation/ph [Physiology] | *Coronary Vessels/pp [Physiopathology] | *Heart Valve Prosthesis Implantation/mt [Methods] | *Regional Blood Flow/ph [Physiology] | Aged, 80 and over | Aortic Valve Stenosis/su [Surgery] | Aortic Valve Stenosis/us [Ultrasonography] | Coronary Vessels/us [Ultrasonography] | Echocardiography, Doppler | Echocardiography, Transesophageal | Feasibility Studies | Female | Follow-Up Studies | Humans | Male | Postoperative Period | Preoperative Period | Prognosis | Retrospective Studies | Severity of Illness Index | Treatment OutcomeYear: 2014Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: Patients with severe aortic stenosis and no obstructed coronary arteries are reported to have reduced coronary flow. Doppler evaluation of proximal coronary flow is feasible using transesophageal echocardiography. The present study aimed to assess the change in coronary flow in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The left main coronary artery was visualized using transesophageal echocardiography in 90 patients undergoing TAVI using the Edwards SAPIEN valve. The peak systolic and diastolic velocities of the coronary flow and the time-velocity integral were obtained before and after TAVI using pulse-wave Doppler. Mean aortic gradients decreased from 47.1 +/- 15.7 mm Hg before TAVI to 3.6 +/- 2.6 mm Hg after TAVI (p <0.001). The aortic valve area increased from 0.58 +/- 0.17 to 1.99 +/- 0.35 cm(2) (p <0.001). The cardiac output increased from 3.4 +/- 1.1 to 3.8 +/- 1.0 L/min (p <0.001). Left ventricular end-diastolic pressure (LVEDP) decreased from 19.8 +/- 5.4 to 17.3 +/- 4.1 mm Hg (p <0.001). The following coronary flow parameters increased significantly after TAVI: peak systolic velocity 24.2 +/- 9.3 to 30.5 +/- 14.9 cm/s (p <0.001), peak diastolic velocity 49.8 +/- 16.9 to 53.7 +/- 22.3 cm/s (p = 0.04), total velocity-time integral 26.7 +/- 10.5 to 29.7 +/- 14.1 cm (p = 0.002), and systolic velocity-time integral 6.1 +/- 3.7 to 7.7 +/- 5.0 cm (p = 0.001). Diastolic time-velocity integral increased from 20.6 +/- 8.7 to 22.0 +/- 10.1 cm (p = 0.04). Total velocity-time integral increased >10% in 43 patients (47.2%). Pearson's correlation coefficient revealed the change in LVEDP as the best correlate of change in coronary flow (R = -0.41, p = 0.003). In conclusion, TAVI resulted in a significant increase in coronary flow. The change in coronary flow was associated mostly with a decrease in LVEDP.Copyright � 2014 Elsevier Inc. All rights reserved.All authors: Ben-Dor I, Goldstein SA, Lindsay J, Magalhaes MA, Malik R, Minha S, Okubagzi PG, Pichard AD, Satler LF, Torguson R, Waksman R, Wang Z, Weissman GFiscal year: FY2015Digital Object Identifier: Date added to catalog: 2015-03-17
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 25173443 Available 25173443

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Patients with severe aortic stenosis and no obstructed coronary arteries are reported to have reduced coronary flow. Doppler evaluation of proximal coronary flow is feasible using transesophageal echocardiography. The present study aimed to assess the change in coronary flow in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The left main coronary artery was visualized using transesophageal echocardiography in 90 patients undergoing TAVI using the Edwards SAPIEN valve. The peak systolic and diastolic velocities of the coronary flow and the time-velocity integral were obtained before and after TAVI using pulse-wave Doppler. Mean aortic gradients decreased from 47.1 +/- 15.7 mm Hg before TAVI to 3.6 +/- 2.6 mm Hg after TAVI (p <0.001). The aortic valve area increased from 0.58 +/- 0.17 to 1.99 +/- 0.35 cm(2) (p <0.001). The cardiac output increased from 3.4 +/- 1.1 to 3.8 +/- 1.0 L/min (p <0.001). Left ventricular end-diastolic pressure (LVEDP) decreased from 19.8 +/- 5.4 to 17.3 +/- 4.1 mm Hg (p <0.001). The following coronary flow parameters increased significantly after TAVI: peak systolic velocity 24.2 +/- 9.3 to 30.5 +/- 14.9 cm/s (p <0.001), peak diastolic velocity 49.8 +/- 16.9 to 53.7 +/- 22.3 cm/s (p = 0.04), total velocity-time integral 26.7 +/- 10.5 to 29.7 +/- 14.1 cm (p = 0.002), and systolic velocity-time integral 6.1 +/- 3.7 to 7.7 +/- 5.0 cm (p = 0.001). Diastolic time-velocity integral increased from 20.6 +/- 8.7 to 22.0 +/- 10.1 cm (p = 0.04). Total velocity-time integral increased >10% in 43 patients (47.2%). Pearson's correlation coefficient revealed the change in LVEDP as the best correlate of change in coronary flow (R = -0.41, p = 0.003). In conclusion, TAVI resulted in a significant increase in coronary flow. The change in coronary flow was associated mostly with a decrease in LVEDP.Copyright � 2014 Elsevier Inc. All rights reserved.

English

Powered by Koha