Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 7;20(19):e1248-e1528.
doi: 10.4244/EIJ-D-24-00075.

Absolute coronary flow and microvascular resistance before and after transcatheter aortic valve implantation

Emanuele Gallinoro  1   2 , Pasquale Paolisso  1   2 , Dario Tino Bertolone  1 , Giuseppe Esposito  1   3 , Marta Belmonte  1   3 , Attilio Leone  1   3 , Michele Mattia Viscusi  1   3 , Monika Shumkova  1 , Cristina De Colle  1 , Ivan Degrieck  1 , Filip Casselman  1 , Martin Penicka  1 , Carlos Collet  1 , Jeroen Sonck  1 , Eric Wyffels  1 , Jozef Bartunek  1 , Bernard De Bruyne  1   4 , Marc Vanderheyden  1 , Emanuele Barbato  1   5
Affiliations

Absolute coronary flow and microvascular resistance before and after transcatheter aortic valve implantation

Emanuele Gallinoro et al. EuroIntervention. .

Abstract

Background: Severe aortic stenosis (AS) is associated with left ventricular (LV) remodelling, likely causing alterations in coronary blood flow and microvascular resistance.

Aims: We aimed to evaluate changes in absolute coronary flow and microvascular resistance in patients with AS undergoing transcatheter aortic valve implantation (TAVI).

Methods: Consecutive patients with AS undergoing TAVI with non-obstructive coronary artery disease in the left anterior descending artery (LAD) were included. Absolute coronary flow (Q) and microvascular resistance (Rμ) were measured in the LAD using continuous intracoronary thermodilution at rest and during hyperaemia before and after TAVI, and at 6-month follow-up. Total myocardial mass and LAD-specific mass were quantified by echocardiography and cardiac computed tomography. Regional myocardial perfusion (QN) was calculated by dividing absolute flow by the subtended myocardial mass.

Results: In 51 patients, Q and R were measured at rest and during hyperaemia before and after TAVI; in 20 (39%) patients, measurements were also obtained 6 months after TAVI. No changes occurred in resting and hyperaemic flow and resistance before and after TAVI nor after 6 months. However, at 6-month follow-up, a notable reverse LV remodelling resulted in a significant increase in hyperaemic perfusion (QN,hyper: 0.86 [interquartile range {IQR} 0.691.06] vs 1.20 [IQR 0.99-1.32] mL/min/g; p=0.008; pre-TAVI and follow-up, respectively) but not in resting perfusion (QN,rest: 0.34 [IQR 0.30-0.48] vs 0.47 [IQR 0.36-0.67] mL/min/g; p=0.06).

Conclusions: Immediately after TAVI, no changes occurred in absolute coronary flow or coronary flow reserve. Over time, the remodelling of the left ventricle is associated with increased hyperaemic perfusion.

PubMed Disclaimer

Conflict of interest statement

P. Paolisso, D.T. Bertolone, G. Esposito, M. Belmonte, A. Leone, and M.M. Viscusi are supported by a research grant from the CardioPaTh PhD programme. E. Barbato declares speaker fees from Abbott, Boston Scientific, and GE HealthCare. C. Collet reports receiving research grants from Biosensors, GE HealthCare, Medis Medical Imaging, Pie Medical Imaging, CathWorks, Boston Scientific, Siemens, HeartFlow, and Abbott; and consultancy fees from HeartFlow, Opsens, Pie Medical Imaging, Abbott, and Philips. B. De Bruyne has institutional consulting relationships with Boston Scientific, Abbott, CathWorks, Siemens, GE HealthCare, and Coroventis Research; receives institutional research grants from Abbott, Coroventis Research, CathWorks, and Boston Scientific; and holds minor equities in Philips, Siemens, GE HealthCare, Edwards Lifesciences, HeartFlow, Opsens, and Celiad. The other authors have no conflicts of interest to declare.

References

    1. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis, De Paulis, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EuroIntervention. 2022;17:e1126–96. - PMC - PubMed
    1. McConkey HZR, Marber M, Chiribiri A, Pibarot P, Redwood SR, Prendergast BD. Coronary Microcirculation in Aortic Stenosis. Circ Cardiovasc Interv. 2019;12:e007547. - PMC - PubMed
    1. Paolisso P, Gallinoro E, Vanderheyden M, Esposito G, Bertolone DT, Belmonte M, Mileva N, Bermpeis K, De Colle, Fabbricatore D, Candreva A, Munhoz D, Degrieck I, Casselman F, Penicka M, Collet C, Sonck J, Mangiacapra F, de Bruyne, Barbato E. Absolute coronary flow and microvascular resistance reserve in patients with severe aortic stenosis. Heart. 2022;109:47–54. - PubMed
    1. Kern MJ, Seto AH. Understanding the mechanism of improved CFR after TAVR/SAVR - the importance of basal flow. EuroIntervention. 2023;18:1129–30. - PMC - PubMed
    1. Scarsini R, Gallinoro E, Ancona MB, Portolan L, Paolisso P, Springhetti P, Della Mora, Mainardi A, Belmonte M, Moroni F, Ferri LA, Bellini B, Russo F, Vella C, Bertolone DT, Pesarini G, Benfari G, Vanderheyden M, Montorfano M, De Bruyne, Barbato E, Ribichini F. Characterisation of coronary microvascular dysfunction in patients with severe aortic stenosis undergoing TAVI. EuroIntervention. 2024;20:e289–300. - PMC - PubMed

MeSH terms

LinkOut - more resources