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Coronary blood flow in patients with severe aortic stenosis before and after transcatheter aortic valve implantation.
Ben-Dor, Itsik; Malik, Rahul; Minha, Sa'ar; Goldstein, Steven A; Wang, Zuyue; Magalhaes, Marco A; Weissman, Gaby; Okubagzi, Petros G; Torguson, Rebecca; Lindsay, Joseph; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron.
Afiliação
  • Ben-Dor I; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Malik R; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Minha S; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Goldstein SA; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Wang Z; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Magalhaes MA; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Weissman G; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Okubagzi PG; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Torguson R; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Lindsay J; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Satler LF; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Pichard AD; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
  • Waksman R; Division of Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
Am J Cardiol ; 114(8): 1264-8, 2014 Oct 15.
Article em En | MEDLINE | ID: mdl-25173443
ABSTRACT
Patients with severe aortic stenosis and no obstructed coronary arteries are reported to have reduced coronary flow. Doppler evaluation of proximal coronary flow is feasible using transesophageal echocardiography. The present study aimed to assess the change in coronary flow in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The left main coronary artery was visualized using transesophageal echocardiography in 90 patients undergoing TAVI using the Edwards SAPIEN valve. The peak systolic and diastolic velocities of the coronary flow and the time-velocity integral were obtained before and after TAVI using pulse-wave Doppler. Mean aortic gradients decreased from 47.1 ± 15.7 mm Hg before TAVI to 3.6 ± 2.6 mm Hg after TAVI (p <0.001). The aortic valve area increased from 0.58 ± 0.17 to 1.99 ± 0.35 cm(2) (p <0.001). The cardiac output increased from 3.4 ± 1.1 to 3.8 ± 1.0 L/min (p <0.001). Left ventricular end-diastolic pressure (LVEDP) decreased from 19.8 ± 5.4 to 17.3 ± 4.1 mm Hg (p <0.001). The following coronary flow parameters increased significantly after TAVI peak systolic velocity 24.2 ± 9.3 to 30.5 ± 14.9 cm/s (p <0.001), peak diastolic velocity 49.8 ± 16.9 to 53.7 ± 22.3 cm/s (p = 0.04), total velocity-time integral 26.7 ± 10.5 to 29.7 ± 14.1 cm (p = 0.002), and systolic velocity-time integral 6.1 ± 3.7 to 7.7 ± 5.0 cm (p = 0.001). Diastolic time-velocity integral increased from 20.6 ± 8.7 to 22.0 ± 10.1 cm (p = 0.04). Total velocity-time integral increased >10% in 43 patients (47.2%). Pearson's correlation coefficient revealed the change in LVEDP as the best correlate of change in coronary flow (R = -0.41, p = 0.003). In conclusion, TAVI resulted in a significant increase in coronary flow. The change in coronary flow was associated mostly with a decrease in LVEDP.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Estenose da Valva Aórtica / Fluxo Sanguíneo Regional / Cateterismo Cardíaco / Circulação Coronária / Vasos Coronários / Implante de Prótese de Valva Cardíaca Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged80 / Female / Humans / Male Idioma: En Revista: Am J Cardiol Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Estenose da Valva Aórtica / Fluxo Sanguíneo Regional / Cateterismo Cardíaco / Circulação Coronária / Vasos Coronários / Implante de Prótese de Valva Cardíaca Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged80 / Female / Humans / Male Idioma: En Revista: Am J Cardiol Ano de publicação: 2014 Tipo de documento: Article