Myocardial Blood Flow Reserve, Microvascular Coronary Health, and Myocardial Remodeling in Patients With Aortic Stenosis.

Autor: Alahdab F; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Ahmed AI; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Nayfeh M; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Han Y; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Abdelkarim O; Department of Cardiology, Faculty of Medicine Alexandria University Alexandria Egypt., Alfawara MS; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Little SH; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Reardon MJ; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Faza NN; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Goel SS; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Alkhouli M; Department of Cardiovascular Medicine Mayo Clinic Rochester MN., Zoghbi W; Houston Methodist DeBakey Heart and Vascular Center Houston TX., Al-Mallah MH; Houston Methodist DeBakey Heart and Vascular Center Houston TX.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Jun 04; Vol. 13 (11), pp. e033447. Date of Electronic Publication: 2024 May 23.
DOI: 10.1161/JAHA.123.033447
Abstrakt: Background: Coronary microvascular function and hemodynamics may play a role in coronary circulation and myocardial remodeling in patients with aortic stenosis (AS). We aimed to evaluate the relationship between myocardial blood flow and myocardial function in patients with AS, no AS, and aortic valve sclerosis.
Methods and Results: We included consecutive patients who had resting transthoracic echocardiography and clinically indicated positron emission tomography myocardial perfusion imaging to capture their left ventricular ejection fraction, global longitudinal strain (GLS), and myocardial flow reserve (MFR). The primary outcome was major adverse cardiovascular event (all-cause mortality, myocardial infarction, or late revascularization). There were 2778 patients (208 with aortic sclerosis, 39 with prosthetic aortic valve, 2406 with no AS, and 54, 49, and 22 with mild, moderate, and severe AS, respectively). Increasing AS severity was associated with impaired MFR ( P <0.001) and GLS ( P <0.001), even when perfusion was normal. Statistically significant associations were noted between MFR and GLS, MFR and left ventricular ejection fraction, and MFR and left ventricular ejection fraction reserve. After a median follow-up of 349 (interquartile range, 116-662) days, 4 (7.4%), 5 (10.2%), and 6 (27.3%) patients experienced a major adverse cardiovascular event in the mild, moderate, and severe AS groups, respectively. In a matched-control analysis, patients with mild-to-moderate AS had higher rates of impaired MFR (52.9% versus 39.9%; P =0.048) and major adverse cardiovascular event (11.8% versus 3.0%; P =0.002).
Conclusions: Despite lack of ischemia, as severity of AS increased, MFR decreased and GLS worsened, reflecting worse coronary microvascular health and myocardial remodeling. Positron emission tomography-derived MFR showed a significant independent correlation with left ventricular ejection fraction and GLS. Patients with prosthetic aortic valve showed a high prevalence of impaired MFR.
Databáze: MEDLINE
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