Coronary Flow Characteristics of Left Coronary Artery in Aortic Regurgitation before and after Aortic Valve Replacement

Fujiwara, Takashi; Nogami, Atsushi; Hara, Masaki; Yamane, H; Kanazawa, S.; Matsuoka, Shuji; Yoshida, Hiroshi; Katsumura, T; Ogasawara, Yasuo; Kajiya, Fumihiko

doi:10.1016/s0003-4975(10)65858-4

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…The predominance of CBF in diastole that occurs in normal individuals also occurs in persons with HTN . In contrast, as delineated in the present study, there is a consistent change in CBF in AR, with less CBF in diastole and more CBF in systole . These data can be supported by the findings with experimentally induced acute AR …”

Section: Discussionsupporting

confidence: 87%

“…Aortic‐valve replacement was associated with a return to the usual phasic CBF (ie, it changed from an overwhelmingly systolic event to a diastolic event; (see Supporting Figure 6 in the online version of this article). This was consistently evident in all studies in which it was examined . Data could only be combined for 2 studies, each of which showed a significant reduction in the systolic/diastolic flow ratio after AVR.…”

Section: Resultsmentioning

confidence: 92%

“…The systolic/diastolic flow ratio was increased in each of the studies, although it was only significant in 3 of the 4 studies. In another study without a control group, a high systolic/diastolic flow ratio was also noted . Sensitivity analysis showed that exclusion of any single study from the analysis did not significantly alter the overall findings.…”

Section: Resultsmentioning

confidence: 93%

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Differences in Coronary Blood Flow in Aortic Regurgitation and Systemic Arterial Hypertension Have Implications for Diastolic Blood Pressure Targets: A Systematic Review and Meta‐Analysis

Rabkin

2013

Clinical Cardiology

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The objective was to evaluate coronary blood flow (CBF) in patients with systemic arterial hypertension (HTN) and to compare it with CBF in patients with aortic regurgitation (AR). A systematic literature search was conducted using the reference terms ''coronary blood flow'' and either ''aortic regurgitation'' or ''hypertension.'' The selection criteria included CBF measurement in a concomitant control group, except studies evaluating CBF with aortic-valve replacement surgery. Twenty-two studies met the inclusion criteria. There were 318 persons with HTN, with 185 controls; and 102 persons with AR, with 144 controls. Despite an overall increase in CBF in HTN, CBF per gram of left ventricular mass was significantly (P < 0.0001) reduced. In contrast, CBF per gram of left ventricular mass was significantly (P = 0.004) increased in AR. Aortic regurgitation was associated with a significant (P < 0.0001) increase in CBF during systole and away from diastole, in contrast to persons with HTN. Aortic-valve replacement reversed the increase in systolic CBF. These data suggest that patients with HTN are more vulnerable than patients with AR to lower diastolic blood pressure (DBP), because resting CBF is compromised in HTN. Furthermore, patients with HTN may not compensate for DBP reductions by shifting CBF to systole, such as can occur with the low DBP in AR. Lower DBP in patients with AR cannot be used to justify treating patients with HTN to similar DBP because of the dramatic differences in CBF between the 2 conditions.

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Section: Discussionsupporting

confidence: 87%

Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 93%

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Differences in Coronary Blood Flow in Aortic Regurgitation and Systemic Arterial Hypertension Have Implications for Diastolic Blood Pressure Targets: A Systematic Review and Meta‐Analysis

Rabkin

2013

Clinical Cardiology

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“…The epicardial coronary flow velocity (CFV) pattern of healthy humans is biphasic with a larger diastolic component and a smaller systolic component. In patients with severe chronic AR the ratio of systolic to diastolic CFVs increases as the severity of AR increases [1,2,8,9] to the extent that mid-diastolic backward flow or negative net diastolic coronary flow has been noted with a resting systolic/diastolic ratio >1.0 [10]. The ratio of the resting systolic-to-diastolic CFV-time integral increases parallel to the increasing ratio of aortic systolic-to-diastolic pressure in patients with worsening AR [1].…”

Section: Discussionmentioning

confidence: 99%

“…First, an earlier surgical intervention when the AR is less than severe may be indicated. The coronary flow abnormalities seen in AR are reversed with valve replacement [8,13] thus minimising one of the possible factors contributing to the pathophysiology of myonecrosis. Second, the presence of sizeable microfistulae may alter the effectiveness of retrograde cardioplegia in myocardial protection during cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Aortic Regurgitation and Coronary Microfistulae: Double Jeopardy Causing Myonecrosis

Chattopadhyay

John²

2011

Cardiology

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Model‐based analysis of the sensitivities and diagnostic implications of FFR and CFR under various pathological conditions

Liu

et al. 2019

Numer Methods Biomed Eng

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Although fractional flow reserve (FFR) and coronary flow reserve (CFR) are both frequently used to assess the functional severity of coronary artery stenosis, discordant results of diagnosis between FFR and CFR in some patient cohorts have been reported. In the present study, a computational model was employed to quantify the impacts of various pathophysiological factors on FFR and CFR. In addition, a hyperemic myocardial ischemic index (HMIx) was proposed as a reference for comparing the diagnostic performances of FFR and CFR. Obtained results showed that CFR was more susceptible than FFR to the influence of many pathophysiological factors unrelated to coronary artery stenosis. In particular, the numerical study proved that increasing hyperemic coronary microvascular resistance significantly elevated FFR while reducing CFR despite fixed severity of coronary artery stenosis, whereas introducing aortic valve disease only caused a significant decrease in CFR with little influence on FFR. These results provided theoretical evidence for explaining some clinical observations, such as the increased risk of discordant diagnostic results between FFR and CFR in patients with increased hyperemic microvascular resistance, and significant increase in CFR after surgical relief of severe aortic valve disease. When evaluated with respect to the predictive value for hyperemic myocardial ischemia, the performance of FFR was found to be considerably compromised in the presence of severe coronary vasodilation dysfunction or aortic valve disease, whereas the relationship between CFR and HMIx remained relatively stable, suggesting that CFR may be a more reliable indicator of myocardial ischemia under complex pathophysiological conditions.

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Coronary Flow Characteristics of Left Coronary Artery in Aortic Regurgitation before and after Aortic Valve Replacement

Cited by 11 publications

References 12 publications

Differences in Coronary Blood Flow in Aortic Regurgitation and Systemic Arterial Hypertension Have Implications for Diastolic Blood Pressure Targets: A Systematic Review and Meta‐Analysis

Differences in Coronary Blood Flow in Aortic Regurgitation and Systemic Arterial Hypertension Have Implications for Diastolic Blood Pressure Targets: A Systematic Review and Meta‐Analysis

Aortic Regurgitation and Coronary Microfistulae: Double Jeopardy Causing Myonecrosis

Model‐based analysis of the sensitivities and diagnostic implications of FFR and CFR under various pathological conditions

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