Transcatheter Replacement of Stenotic Aortic Valve Normalizes Cardiac–Coronary Interaction by Restoration of Systolic Coronary Flow Dynamics as Assessed by Wave Intensity Analysis
BACKGROUND—Aortic valve stenosis (AS) can cause angina despite unobstructed coronary arteries, which may be related to increased compression of the intramural microcirculation, especially at the subendocardium. We assessed coronary wave intensity and phasic flow velocity patterns to unravel changes...
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| Veröffentlicht in: | Circulation. Cardiovascular interventions 2016-04, Vol.9 (4), p.e002356-e002356 |
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| container_title | Circulation. Cardiovascular interventions |
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| creator | Rolandi, M Cristina Wiegerinck, Esther M.A Casadonte, Lorena Yong, Ze-Yie Koch, Karel T Vis, Marije Piek, Jan J Baan, Jan Spaan, Jos A.E Siebes, Maria |
| description | BACKGROUND—Aortic valve stenosis (AS) can cause angina despite unobstructed coronary arteries, which may be related to increased compression of the intramural microcirculation, especially at the subendocardium. We assessed coronary wave intensity and phasic flow velocity patterns to unravel changes in cardiac–coronary interaction because of transcatheter aortic valve implantation (TAVI).
METHODS AND RESULTS—Intracoronary pressure and flow velocity were measured at rest and maximal hyperemia in undiseased vessels in 15 patients with AS before and after TAVI and in 12 control patients. Coronary flow reserve, systolic and diastolic velocity time integrals, and the energies of forward (aorta-originating) and backward (microcirculatory-originating) coronary waves were determined. Coronary flow reserve was 2.8±0.2 (mean±SEM) in control and 1.8±0.1 in AS (P30%. The increase in forward compression wave with TAVI was related to an increase in systolic velocity time integral. AS or TAVI did not alter diastolic velocity time integral.
CONCLUSIONS—Reduced coronary forward wave energy and systolic velocity time integral imply a compromised systolic flow velocity with AS that is restored after TAVI, suggesting an acute relief of excess compression in systole that likely benefits subendocardial perfusion. Vasodilation is observed to be a major determinant of backward waves. |
| doi_str_mv | 10.1161/CIRCINTERVENTIONS.114.002356 |
| format | Article |
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METHODS AND RESULTS—Intracoronary pressure and flow velocity were measured at rest and maximal hyperemia in undiseased vessels in 15 patients with AS before and after TAVI and in 12 control patients. Coronary flow reserve, systolic and diastolic velocity time integrals, and the energies of forward (aorta-originating) and backward (microcirculatory-originating) coronary waves were determined. Coronary flow reserve was 2.8±0.2 (mean±SEM) in control and 1.8±0.1 in AS (P<0.005) and was not restored by TAVI. Compared with control, the resting backward expansion wave was 45% higher in AS. The peak of the systolic forward compression wave was delayed in AS, consistent with a delayed peak aortic pressure, which was partially restored after TAVI. The energy of forward waves doubled after TAVI, whereas the backward expansion wave increased by >30%. The increase in forward compression wave with TAVI was related to an increase in systolic velocity time integral. AS or TAVI did not alter diastolic velocity time integral.
CONCLUSIONS—Reduced coronary forward wave energy and systolic velocity time integral imply a compromised systolic flow velocity with AS that is restored after TAVI, suggesting an acute relief of excess compression in systole that likely benefits subendocardial perfusion. Vasodilation is observed to be a major determinant of backward waves.</description><identifier>ISSN: 1941-7640</identifier><identifier>EISSN: 1941-7632</identifier><identifier>DOI: 10.1161/CIRCINTERVENTIONS.114.002356</identifier><identifier>PMID: 27001805</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve - physiopathology ; Aortic Valve Stenosis - diagnosis ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - therapy ; Blood Flow Velocity ; Cardiac Catheterization - instrumentation ; Case-Control Studies ; Coronary Angiography ; Coronary Circulation ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - physiopathology ; Female ; Heart Valve Prosthesis Implantation - instrumentation ; Heart Valve Prosthesis Implantation - methods ; Hemodynamics ; Humans ; Male ; Middle Aged ; Pulsatile Flow ; Recovery of Function ; Systole ; Time Factors ; Treatment Outcome ; Vasodilation</subject><ispartof>Circulation. Cardiovascular interventions, 2016-04, Vol.9 (4), p.e002356-e002356</ispartof><rights>2016 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4887-79cf4e5c2b80ad07cf8a2c6871ef25d7cd8a795710796364cdc338bc5b3969153</citedby><cites>FETCH-LOGICAL-c4887-79cf4e5c2b80ad07cf8a2c6871ef25d7cd8a795710796364cdc338bc5b3969153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27001805$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rolandi, M Cristina</creatorcontrib><creatorcontrib>Wiegerinck, Esther M.A</creatorcontrib><creatorcontrib>Casadonte, Lorena</creatorcontrib><creatorcontrib>Yong, Ze-Yie</creatorcontrib><creatorcontrib>Koch, Karel T</creatorcontrib><creatorcontrib>Vis, Marije</creatorcontrib><creatorcontrib>Piek, Jan J</creatorcontrib><creatorcontrib>Baan, Jan</creatorcontrib><creatorcontrib>Spaan, Jos A.E</creatorcontrib><creatorcontrib>Siebes, Maria</creatorcontrib><title>Transcatheter Replacement of Stenotic Aortic Valve Normalizes Cardiac–Coronary Interaction by Restoration of Systolic Coronary Flow Dynamics as Assessed by Wave Intensity Analysis</title><title>Circulation. Cardiovascular interventions</title><addtitle>Circ Cardiovasc Interv</addtitle><description>BACKGROUND—Aortic valve stenosis (AS) can cause angina despite unobstructed coronary arteries, which may be related to increased compression of the intramural microcirculation, especially at the subendocardium. We assessed coronary wave intensity and phasic flow velocity patterns to unravel changes in cardiac–coronary interaction because of transcatheter aortic valve implantation (TAVI).
METHODS AND RESULTS—Intracoronary pressure and flow velocity were measured at rest and maximal hyperemia in undiseased vessels in 15 patients with AS before and after TAVI and in 12 control patients. Coronary flow reserve, systolic and diastolic velocity time integrals, and the energies of forward (aorta-originating) and backward (microcirculatory-originating) coronary waves were determined. Coronary flow reserve was 2.8±0.2 (mean±SEM) in control and 1.8±0.1 in AS (P<0.005) and was not restored by TAVI. Compared with control, the resting backward expansion wave was 45% higher in AS. The peak of the systolic forward compression wave was delayed in AS, consistent with a delayed peak aortic pressure, which was partially restored after TAVI. The energy of forward waves doubled after TAVI, whereas the backward expansion wave increased by >30%. The increase in forward compression wave with TAVI was related to an increase in systolic velocity time integral. AS or TAVI did not alter diastolic velocity time integral.
CONCLUSIONS—Reduced coronary forward wave energy and systolic velocity time integral imply a compromised systolic flow velocity with AS that is restored after TAVI, suggesting an acute relief of excess compression in systole that likely benefits subendocardial perfusion. Vasodilation is observed to be a major determinant of backward waves.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve - physiopathology</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - therapy</subject><subject>Blood Flow Velocity</subject><subject>Cardiac Catheterization - instrumentation</subject><subject>Case-Control Studies</subject><subject>Coronary Angiography</subject><subject>Coronary Circulation</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - physiopathology</subject><subject>Female</subject><subject>Heart Valve Prosthesis Implantation - instrumentation</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pulsatile Flow</subject><subject>Recovery of Function</subject><subject>Systole</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vasodilation</subject><issn>1941-7640</issn><issn>1941-7632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplUcuO1DAQjBCIfcAvIB84cMnSjhM7kbiMwixEWs1Ks8NyjDqOowk49mBnGIXT_gPfwg_xJTjMMhckW-0uVVWrXVH0msIVpZy-Lat1Wa02y_X9crWpbld3AU6vABKW8SfROS1SGgvOkqendwpn0YX3XwACzJPn0VkiAGgO2Xn0a-PQeInjVo3KkbXaaZRqUGYktiN3ozJ27CVZWDeXe9TfFVlZN6DufyhPSnRtj_L3w8_SOmvQTaQywQjl2FtDmik4-tE6_NvOjlNodbA68a-1PZD3k8Ghl56gJwvvVTjtrP6MYd7saHw_TmRhUE--9y-iZx1qr14-1svo0_VyU36Mb24_VOXiJpZpnotYFLJLVSaTJgdsQcgux0TyXFDVJVkrZJujKDJBQRSc8VS2krG8kVnDCl7QjF1Gb46-O2e_7cMm9dB7qbRGo-ze11SIjAnBgQXquyNVOuu9U129c_0QFqwp1HNw9X_BBTitj8EF-avHSftmUO1J_C-pQEiPhIPV4YP9V70_KFdvFepxWwNlTKRFFidAOaQAEIdLBfsDS6irxA</recordid><startdate>201604</startdate><enddate>201604</enddate><creator>Rolandi, M Cristina</creator><creator>Wiegerinck, Esther M.A</creator><creator>Casadonte, Lorena</creator><creator>Yong, Ze-Yie</creator><creator>Koch, Karel T</creator><creator>Vis, Marije</creator><creator>Piek, Jan J</creator><creator>Baan, Jan</creator><creator>Spaan, Jos A.E</creator><creator>Siebes, Maria</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201604</creationdate><title>Transcatheter Replacement of Stenotic Aortic Valve Normalizes Cardiac–Coronary Interaction by Restoration of Systolic Coronary Flow Dynamics as Assessed by Wave Intensity Analysis</title><author>Rolandi, M Cristina ; Wiegerinck, Esther M.A ; Casadonte, Lorena ; Yong, Ze-Yie ; Koch, Karel T ; Vis, Marije ; Piek, Jan J ; Baan, Jan ; Spaan, Jos A.E ; Siebes, Maria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4887-79cf4e5c2b80ad07cf8a2c6871ef25d7cd8a795710796364cdc338bc5b3969153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve - physiopathology</topic><topic>Aortic Valve Stenosis - diagnosis</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - therapy</topic><topic>Blood Flow Velocity</topic><topic>Cardiac Catheterization - instrumentation</topic><topic>Case-Control Studies</topic><topic>Coronary Angiography</topic><topic>Coronary Circulation</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - physiopathology</topic><topic>Female</topic><topic>Heart Valve Prosthesis Implantation - instrumentation</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pulsatile Flow</topic><topic>Recovery of Function</topic><topic>Systole</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vasodilation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rolandi, M Cristina</creatorcontrib><creatorcontrib>Wiegerinck, Esther M.A</creatorcontrib><creatorcontrib>Casadonte, Lorena</creatorcontrib><creatorcontrib>Yong, Ze-Yie</creatorcontrib><creatorcontrib>Koch, Karel T</creatorcontrib><creatorcontrib>Vis, Marije</creatorcontrib><creatorcontrib>Piek, Jan J</creatorcontrib><creatorcontrib>Baan, Jan</creatorcontrib><creatorcontrib>Spaan, Jos A.E</creatorcontrib><creatorcontrib>Siebes, Maria</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rolandi, M Cristina</au><au>Wiegerinck, Esther M.A</au><au>Casadonte, Lorena</au><au>Yong, Ze-Yie</au><au>Koch, Karel T</au><au>Vis, Marije</au><au>Piek, Jan J</au><au>Baan, Jan</au><au>Spaan, Jos A.E</au><au>Siebes, Maria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transcatheter Replacement of Stenotic Aortic Valve Normalizes Cardiac–Coronary Interaction by Restoration of Systolic Coronary Flow Dynamics as Assessed by Wave Intensity Analysis</atitle><jtitle>Circulation. Cardiovascular interventions</jtitle><addtitle>Circ Cardiovasc Interv</addtitle><date>2016-04</date><risdate>2016</risdate><volume>9</volume><issue>4</issue><spage>e002356</spage><epage>e002356</epage><pages>e002356-e002356</pages><issn>1941-7640</issn><eissn>1941-7632</eissn><abstract>BACKGROUND—Aortic valve stenosis (AS) can cause angina despite unobstructed coronary arteries, which may be related to increased compression of the intramural microcirculation, especially at the subendocardium. We assessed coronary wave intensity and phasic flow velocity patterns to unravel changes in cardiac–coronary interaction because of transcatheter aortic valve implantation (TAVI).
METHODS AND RESULTS—Intracoronary pressure and flow velocity were measured at rest and maximal hyperemia in undiseased vessels in 15 patients with AS before and after TAVI and in 12 control patients. Coronary flow reserve, systolic and diastolic velocity time integrals, and the energies of forward (aorta-originating) and backward (microcirculatory-originating) coronary waves were determined. Coronary flow reserve was 2.8±0.2 (mean±SEM) in control and 1.8±0.1 in AS (P<0.005) and was not restored by TAVI. Compared with control, the resting backward expansion wave was 45% higher in AS. The peak of the systolic forward compression wave was delayed in AS, consistent with a delayed peak aortic pressure, which was partially restored after TAVI. The energy of forward waves doubled after TAVI, whereas the backward expansion wave increased by >30%. The increase in forward compression wave with TAVI was related to an increase in systolic velocity time integral. AS or TAVI did not alter diastolic velocity time integral.
CONCLUSIONS—Reduced coronary forward wave energy and systolic velocity time integral imply a compromised systolic flow velocity with AS that is restored after TAVI, suggesting an acute relief of excess compression in systole that likely benefits subendocardial perfusion. Vasodilation is observed to be a major determinant of backward waves.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>27001805</pmid><doi>10.1161/CIRCINTERVENTIONS.114.002356</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1941-7640 |
| ispartof | Circulation. Cardiovascular interventions, 2016-04, Vol.9 (4), p.e002356-e002356 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Aged, 80 and over Aortic Valve - physiopathology Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - therapy Blood Flow Velocity Cardiac Catheterization - instrumentation Case-Control Studies Coronary Angiography Coronary Circulation Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Female Heart Valve Prosthesis Implantation - instrumentation Heart Valve Prosthesis Implantation - methods Hemodynamics Humans Male Middle Aged Pulsatile Flow Recovery of Function Systole Time Factors Treatment Outcome Vasodilation |
| title | Transcatheter Replacement of Stenotic Aortic Valve Normalizes Cardiac–Coronary Interaction by Restoration of Systolic Coronary Flow Dynamics as Assessed by Wave Intensity Analysis |
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