Coronary Flow Velocity Waveforms in Aortic Stenosis and the Effects of Valve Replacement

Transcatheter Replacement of Stenotic Aortic Valve Normalizes Cardiac–Coronary Interaction by Restoration of Systolic Coronary Flow Dynamics as Assessed by Wave Intensity Analysis

“…12 This reasoning is supported by the rise in early and peak systolic flow velocity resulting in an increased VTI sys (Figure 4), which is consistent with earlier observations. 24 In agreement with earlier studies, 25 we did not observe a difference in VTI dia , which follows from the altered diastolic velocity profile, characterized by slow acceleration and a higher peak diastolic velocity in AS. This is consistent with delayed relaxation in diastolic dysfunction because of concentric hypertrophic LV remodeling in patients with AS 1 and delayed diastolic untwisting 26 as a mechanical link to the phasic coronary hemodynamic observations in this scenario.…”

Difference in Coronary Blood Flow Dynamics between Patients with Hypertension and Those with Hypertrophic Cardiomyopathy.

“…Decreased, or sometimes reversed, systolic CBF has been reported in patients with obstructive (7) and non-obstructive HCM (16) and aortic stenosis (17).…”

Effect of aortic valve replacement on coronary flow velocity during metabolic stress in a patient with aortic stenosis

“…Although the disappearance of systolic flow reversal after aortic valve replacement has been demonstrated in patients with aortic stenosis [4,5], little is known of whether this alteration of the flow profile would improve the coronary flow response during metabolic stress and maximal-resistance vessel dilatation. We demonstrated that the response of coronary flow during metabolic and pharmacologic stimuli did not improve in our patient early after aortic valve replacement.…”

“…Systolic flow reversal is observed in patients with increased intramyocardial compressive forces, such as aortic stenosis [2][3][4][5] and hypertrophic obstructive cardiomyopathy [6]. In these conditions, the systolic difference between the intraventricular and aortic blood pressures results in increased intramyocardial compressive forces, which far exceed the systolic capacitance of the large epicardial coronary arteries even at rest, resulting in the appearance of systolic flow reversal [3].…”

“…The mechanism that may account for the development of angina in this subset of patients relates to the reduced coronary vasodilator reserve, because it interferes with an adequate increase of coronary blood flow under stress. In addition, alteration in the phasic coronary flow velocity has been demonstrated, including the development of systolic flow reversal [2][3][4][5]; several studies have reported that this systolic flow reversal disappears after aortic valve replacement [4,5]. However, little is known about whether this alteration in the phasic coronary flow profile early after valve replacement would be accompanied by an improvement in coronary flow response during metabolic stress and resistance vessel dilatation.…”