Document Detail

Arterial pulse wave dynamics after percutaneous aortic valve replacement: fall in coronary diastolic suction with increasing heart rate as a basis for angina symptoms in aortic stenosis.
MedLine Citation:
PMID:  21911781     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Aortic stenosis causes angina despite unobstructed arteries. Measurement of conventional coronary hemodynamic parameters in patients undergoing valvular surgery has failed to explain these symptoms. With the advent of percutaneous aortic valve replacement (PAVR) and developments in coronary pulse wave analysis, it is now possible to instantaneously abolish the valvular stenosis and to measure the resulting changes in waves that direct coronary flow.
METHODS AND RESULTS: Intracoronary pressure and flow velocity were measured immediately before and after PAVR in 11 patients with unobstructed coronary arteries. Using coronary pulse wave analysis, we calculated the intracoronary diastolic suction wave (the principal accelerator of coronary blood flow). To test physiological reserve to increased myocardial demand, we measured at resting heart rate and during pacing at 90 and 120 bpm. Before PAVR, the basal myocardial suction wave intensity was 1.9±0.3×10(-5) W · m(-2) · s(-2), and this increased in magnitude with increasing severity of aortic stenosis (r=0.59, P=0.05). This wave decreased markedly with increasing heart rate (β coefficient=-0.16×10(-4) W · m(-2) · s(-2); P<0.001). After PAVR, despite a fall in basal suction wave (1.9±0.3 versus 1.1±0.1×10(-5) W · m(-2) · s(-2); P=0.02), there was an immediate improvement in coronary physiological reserve with increasing heart rate (β coefficient=0.9×10(-3) W · m(-2) · s(-2); P=0.014).
CONCLUSIONS: In aortic stenosis, the coronary physiological reserve is impaired. Instead of increasing when heart rate rises, the coronary diastolic suction wave decreases. Immediately after PAVR, physiological reserve returns to a normal positive pattern. This may explain how aortic stenosis can induce anginal symptoms and their prompt relief after PAVR. Clinical Trial Registration- URL: Unique identifier: NCT01118442.
Justin E Davies; Sayan Sen; Chris Broyd; Nearchos Hadjiloizou; John Baksi; Darrel P Francis; Rodney A Foale; Kim H Parker; Alun D Hughes; Andrew Chukwuemeka; Roberto Casula; Iqbal S Malik; Ghada W Mikhail; Jamil Mayet
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-09-12
Journal Detail:
Title:  Circulation     Volume:  124     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-04     Completed Date:  2011-11-28     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1565-72     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Angina Pectoris / etiology*,  physiopathology
Aortic Valve / surgery*
Aortic Valve Stenosis / complications*,  physiopathology,  surgery
Coronary Circulation*
Heart Rate
Heart Valve Prosthesis Implantation* / methods
Hypertrophy, Left Ventricular / etiology
Prospective Studies
Pulsatile Flow
Grant Support
FS/10/38/28268//British Heart Foundation; G1000357//Medical Research Council; PG/11/53/28991//British Heart Foundation
Comment In:
Circulation. 2011 Oct 4;124(14):1505-7   [PMID:  21969316 ]
Circulation. 2012 Apr 24;125(16):e612; author reply e613   [PMID:  22529071 ]

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