Regression of left ventricular hypertrophy provides an additive physiological benefit following treatment of aortic stenosis: Insights from serial coronary wave intensity analysis.
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Supporting information
Author(s)
Type
Journal Article
Abstract
AIM: Severe aortic stenosis frequently involves the development of left ventricular hypertrophy (LVH) creating a dichotomous haemodynamic state within the coronary circulation. Whilst the increased force of ventricular contraction enhances its resultant relaxation and thus increases the distal diastolic coronary "suction" force, the presence of LVH has a potentially opposing effect on ventricular-coronary interplay. The aim of this study was to use non-invasive coronary wave intensity analysis (WIA) to separate and measure the sequential effects of outflow tract obstruction relief and then LVH regression following intervention for aortic stenosis. METHODS: Fifteen patients with unobstructed coronary arteries undergoing aortic valve intervention (11 surgical aortic valve replacement [SAVR], 4 TAVI) were successfully assessed before and after intervention, and at 6 and 12 months post-procedure. Coronary WIA was constructed from simultaneously acquired coronary flow from transthoracic echo and pressure from an oscillometric brachial cuff system. RESULTS: Immediately following intervention, a decline in the backward decompression wave (BDW) was noted (9.7 ± 5.7 vs 5.1 ± 3.6 × 103 W/m2 /s, P < 0.01). Over 12 months, LV mass index fell from 114 ± 19 to 82 ± 17 kg/m2 . Accompanying this, the BDW fraction increased to 32.8 ± 7.2% at 6 months (P = 0.01 vs post-procedure) and 34.7 ± 6.7% at 12 months (P < 0.001 vs post-procedure). CONCLUSION: In aortic stenosis, both the outflow tract gradient and the presence of LVH impact significantly on coronary haemodynamics that cannot be appreciated by examining resting coronary flow rates alone. An immediate change in coronary wave intensity occurs following intervention with further effects appreciable with hypertrophy regression. The improvement in prognosis with treatment is likely to be attributable to both features.
Date Issued
2018-06-23
Date Acceptance
2018-05-29
Citation
Acta Physiologica, 2018, 2018, pp.e13109-e13109
ISSN
1748-1708
Publisher
Wiley
Start Page
e13109
End Page
e13109
Journal / Book Title
Acta Physiologica
Volume
2018
Copyright Statement
© 2018 John Wiley & Sons Ltd. This is the pre-peer reviewed version of the following article: Broyd CJ, Rigo F, Nijjer S, et al. Regression of left ventricular hypertrophy provides an additive physiological benefit following treatment of aortic stenosis: Insights from serial coronary wave intensity analysis. Acta Physiol. 2018;e13109., which has been published in final form at https://dx.doi.org/10.1111/apha.13109
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29935058
Subjects
aortic valve replacement/transcatheter aortic valve implantation
haemodynamics
hypertrophy
pathophysiology
valvular heart disease
Publication Status
Published online
Coverage Spatial
England
Article Number
e13109