Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions

Autor: Jo M. Zelis, Pim A. L. Tonino, Nico H. J. Pijls, Bernard De Bruyne, Richard L. Kirkeeide, K. Lance Gould, Nils P. Johnson
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Journal of Interventional Cardiology, Vol 2020 (2020)
Druh dokumentu: article
ISSN: 0896-4327
1540-8183
DOI: 10.1155/2020/4603169
Popis: With the increasing prevalence of aortic stenosis (AS) due to a growing elderly population, a proper understanding of its physiology is paramount to guide therapy and define severity. A better understanding of the microvasculature in AS could improve clinical care by predicting left ventricular remodeling or anticipate the interplay between epicardial stenosis and myocardial dysfunction. In this review, we combine five decades of literature regarding microvascular, coronary, and aortic valve physiology with emerging insights from newly developed invasive tools for quantifying microcirculatory function. Furthermore, we describe the coupling between microcirculation and epicardial stenosis, which is currently under investigation in several randomized trials enrolling subjects with concomitant AS and coronary disease. To clarify the physiology explained previously, we present two instructive cases with invasive pressure measurements quantifying coexisting valve and coronary stenoses. Finally, we pose open clinical and research questions whose answers would further expand our knowledge of microvascular dysfunction in AS. These trials were registered with NCT03042104, NCT03094143, and NCT02436655.
Databáze: Directory of Open Access Journals
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