经导管主动脉瓣植入术前和术后的绝对冠状动脉血流和微血管阻力。

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

机构信息

Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.

Division of University Cardiology, IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy.

出版信息

EuroIntervention. 2024 Oct 7;20(19):e1248-e1528. doi: 10.4244/EIJ-D-24-00075.

DOI:10.4244/EIJ-D-24-00075

PMID:39374094

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11443252/

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 (R) 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 (Q) 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 (Q: 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 (Q: 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.

摘要

背景

严重的主动脉瓣狭窄（AS）与左心室（LV）重构相关，可能导致冠状动脉血流和微血管阻力发生改变。

目的

我们旨在评估行经导管主动脉瓣置换术（TAVI）的 AS 患者的绝对冠状动脉血流和微血管阻力的变化。

方法

连续纳入了左前降支（LAD）无阻塞性冠状动脉疾病且行 TAVI 的 AS 患者。在 TAVI 前后和 6 个月随访时，使用连续冠状动脉内热稀释法测量 LAD 中的绝对冠状动脉血流（Q）和微血管阻力（R）。通过超声心动图和心脏计算机断层扫描定量测量总心肌质量和 LAD 特异性质量。通过将绝对流量除以所涵盖的心肌质量来计算区域心肌灌注（Q）。

结果

在 51 例患者中，在 TAVI 前后的静息状态和充血状态下测量了 Q 和 R；在 20 例（39%）患者中，还在 TAVI 后 6 个月时获得了这些测量值。TAVI 前后以及 6 个月后，静息和充血状态下的血流和阻力均未发生变化。然而，在 6 个月的随访中，明显的 LV 逆向重构导致充血灌注显著增加（Q：0.86 [四分位距 {IQR} 0.69-1.06] 与 1.20 [IQR 0.99-1.32] mL/min/g；p=0.008；分别为 TAVI 前和随访时），但静息灌注无变化（Q：0.34 [IQR 0.30-0.48] 与 0.47 [IQR 0.36-0.67] mL/min/g；p=0.06）。