| Functional changes in coronary microcirculation after valve replacement in patients with aortic stenosis. | |
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MedLine Citation:
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PMID: 12796134 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Increased extravascular compression and reduced diastolic perfusion time (DPT), rather than vascular remodeling, influence coronary microcirculatory dysfunction in aortic stenosis (AS). However, alterations after aortic valve replacement (AVR) remain unclear. The aim of the present study was to quantify changes in transmural perfusion and coronary vasodilator reserve (CVR), a measure of microcirculatory function, after AVR and determine the relative contribution of left ventricular mass (LVM) regression, change in aortic valve area (AVA), and DPT. METHODS AND RESULTS: Twenty-two patients with AS were studied before and 1 year after AVR using echocardiography to measure AVA, cardiovascular magnetic resonance to assess LVM, and positron emission tomography to quantify resting and hyperemic myocardial blood flow (MBF) and CVR. Regression of LVM occurred in all patients (from 129+/-30 to 94+/-24 g/m2; P<0.0001), and there was a significant reduction in resting MBF and increase in CVR corrected for rate-pressure product after AVR, although these changes displayed marked heterogeneity. Regression of LVM was linearly related to change in resting total LV blood flow but not CVR. Increase in hyperemic MBF and CVR transmurally was directly related to the increase in AVA after AVR. A significant relationship existed between the change in hyperemic DPT (1.0+/-4.7 s/min [range, 6.8 to 9.6]) and change in transmural CVR (y=0.08x+0.18; r=0.44; P=0.04). CONCLUSIONS: Changes in coronary microcirculatory function in patients with AS after AVR are not directly dependent on regression of LVM. Reduced extravascular compression and increased DPT are proposed as the main mechanisms for improvement in MBF and CVR after AVR. |
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Authors:
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Kim Rajappan; Ornella E Rimoldi; Paolo G Camici; Nicholas G Bellenger; Dudley J Pennell; Desmond J Sheridan |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't Date: 2003-06-09 |
Journal Detail:
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Title: Circulation Volume: 107 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2003 Jul |
Date Detail:
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Created Date: 2003-07-01 Completed Date: 2003-07-15 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 3170-5 Citation Subset: AIM; IM |
Affiliation:
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Academic Cardiology Unit, St Mary's Hospital, London, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Aortic Valve Stenosis / complications, diagnosis, physiopathology*, surgery Blood Flow Velocity Coronary Circulation* Coronary Vessels / physiopathology, radionuclide imaging, ultrasonography Echocardiography Female Heart Valve Prosthesis Implantation* Hemodynamics Humans Hypertrophy, Left Ventricular / diagnosis, etiology, physiopathology Magnetic Resonance Angiography Male Microcirculation / physiopathology*, radionuclide imaging, ultrasonography Middle Aged Regression Analysis Remission Induction Tomography, Emission-Computed Treatment Outcome Vasodilation / drug effects |
| Comments/Corrections | |
Comment In:
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Circulation. 2003 Jul 1;107(25):3121-3
[PMID:
12835405
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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