Left ventricular afterload reduction by transcatheter aortic valve implantation in severe aortic stenosis and its prompt effects on comprehensive coronary haemodynamics.

Stoller, Michael; Gloekler, Steffen; Zbinden, Rainer; Tueller, David; Eberli, Franz; Windecker, Stephan; Wenaweser, Peter; Seiler, Christian (2018). Left ventricular afterload reduction by transcatheter aortic valve implantation in severe aortic stenosis and its prompt effects on comprehensive coronary haemodynamics. EuroIntervention, 14(2), pp. 166-173. Europa Digital & Publishing 10.4244/EIJ-D-17-00719

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AIMS

In this study we aimed to test the hypothesis that left ventricular (LV) afterload reduction in severe aortic valve stenosis (AS) by transcatheter aortic valve implantation (TAVI) acutely improves coronary haemodynamics.

METHODS AND RESULTS

This was a prospective, pathophysiologic study in 40 patients with severe AS undergoing TAVI. Endpoints were determined invasively immediately before and after TAVI without altering coronary stenotic lesions if present. Myocardial hyperaemia was induced by intravenous adenosine. The primary study endpoints were coronary flow reserve (thermodilution-derived CFR), and fractional flow reserve (FFR). The secondary study endpoint was coronary collateral flow index (CFI) as obtained during a one-minute coronary balloon occlusion. CFR was 1.9±0.9 before TAVI and 2.0±1.0 after TAVI (p=0.72). FFR was 0.90±0.08 before TAVI and 0.93±0.08 after TAVI (p=0.0021). The TAVI-induced increase in FFR was related to a significant decrease in hyperaemic mean aortic pressure from 71±16 mmHg before TAVI to 67±15 mmHg after TAVI (p=0.0099). Hyperaemic CFI increased from 0.127±0.083 before to 0.146±0.090 after TAVI (p=0.0508).

CONCLUSIONS

CFR appears not to be acutely affected by LV afterload reduction among patients with severe AS in response to TAVI. However, it acutely improves FFR; this occurs via lowering of mean aortic pressure. Hyperaemic coronary collateral flow index tends to augment in response to TAVI.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Windecker, Stephan, Seiler, Christian
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1774-024X
Publisher:	Europa Digital & Publishing
Language:	English
Submitter:	Nadia Biscozzo
Date Deposited:	14 Mar 2019 11:10
Last Modified:	05 Dec 2022 15:26
Publisher DOI:	10.4244/EIJ-D-17-00719
PubMed ID:	29553941
URI:	https://boris.unibe.ch/id/eprint/125915