Coronary Microvascular Dysfunction as a Mechanism of Angina in Severe AS

Ahn, Jong Hwa; Kim, Sung Mok; Park, Sung‐Ji; Jeong, Dong Seop; Woo, Min Ah; Jung, Sin Ho; Lee, Sang‐Chol; Park, Seung Woo; Choe, Yeon Hyeon; Park, Pyo Won; Oh, Jae K.

doi:10.1016/j.jacc.2016.01.013

Cited by 53 publications

(53 citation statements)

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“…When ventricular dilatation becomes detectable, pathological alterations such as reduced coronary blood flow per myocardial mass have already occurred [24]. A recent study demonstrated that coronary microvascular dysfunction is a main contributing factor to the development of chest pain in patients with severe AS without obstructive coronary artery disease [25]. Severe AS and LV remodelling reduce myocardial blood flow in the subendocardium, and reduction of flow is related to increased apoptosis of cardiomyoctes, which leads to heart failure [26].…”

Section: Discussionmentioning

confidence: 99%

Determinants and Prognostic Significance of Symptomatic Status in Patients with Moderately Dysfunctional Bicuspid Aortic Valves

et al. 2017

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BackgroundWe aimed to identify the clinical and echocardiographic determinants of symptoms and their prognostic implications in patients with moderately dysfunctional bicuspid aortic valves (BAVs).MethodsAmong 1,019 subjects in the BAV registry treated in a single tertiary care center, the records of 127 patients (85 men, age 58±13 years) with moderately dysfunctional BAVs were comprehensively reviewed. The patients were divided into two groups based on symptom status: asymptomatic (n = 80) vs. symptomatic (n = 47). The primary end-point was defined as a composite of aortic valve surgery, hospitalization for heart failure, and any cause of death.ResultsThe symptomatic group had a higher proportion of females, hypertension, aortic stenosis, and aortopathy than did the asymptomatic group. The symptomatic group showed lower e′ (5.5±1.7 vs. 6.5±2.2 cm/s, p = 0.003), higher E/e′ (13.3 ± 4.9 vs. 10.9±3.7, p = 0.002), and larger left atrial volume index (29.9±11.4 vs. 24.6±9.1 ml/m2, p = 0.006) than did the asymptomatic group. In multivariate logistic regression analysis, female gender (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.10–7.36, p = 0.031), hypertension (OR 3.07, 95% CI 1.20–7.82, p = 0.019), moderate aortic stenosis (OR 5.33 5.78, 95% CI 1.99–16.83, p = 0.001), E/e′ >15 (OR 3.82, 95% CI 1.03–11.19, p = 0.015), and aortopathy (OR 2.76, 95% CI 1.07–7.10, p = 0.035) were independently correlated with symptom status. The symptomatic group showed a significantly lower rate of event-free survival during the 8-year follow-up period (54±9% vs. 68±10%, p = 0.001).ConclusionsIn patients with moderately dysfunctional BAVs, the presence of moderate aortic stenosis, aortopathy, and diastolic dysfunction determines symptom status, along with female gender and hypertension. Symptom status was associated with clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Determinants and Prognostic Significance of Symptomatic Status in Patients with Moderately Dysfunctional Bicuspid Aortic Valves

et al. 2017

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“…This can be particularly useful in identifying the aetiology of symptoms in those with moderate or borderline severe AS, who may have underlying coronary artery disease. In addition, it can demonstrate global subendocardial perfusion defects commonly seen in the hypertrophied myocardium, which represents microvascular dysfunction/insufficiency which contributes to the development of angina even in patients with non-obstructed coronary arteries40 (figure 7). …”

Section: Assessment Of the Myocardiummentioning

confidence: 99%

Cardiac magnetic resonance imaging for the assessment of aortic stenosis

Singh

McCann²

2018

Heart

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“…Among severe AS patients with angina but no obstructive CAD, Park et al [7] demonstrated a reduced myocardial perfusion reserve, which is indicative of microvascular dysfunction, compared with severe AS patients without any symptoms [45]. Park et al [7] suggests that angina in patients with severe AS without obstructive CAD might be attributed to LVH, which can cause myocardial ischemia by coronary microvascular dysfunction (Fig.…”

Section: Anginamentioning

confidence: 99%

Symptomatic presentations of severe aortic stenosis

Park

2017

Precis Future Med

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Aortic stenosis (AS) is the most common type of valvular heart disease. A manifestation of ageing, the disorder is becoming more frequent as the average age of the population increases. Onset of cardinal manifestation of AS-angina, syncope, and heart failureremains the major demarcation point in the disease's course. It has been well described that patients' survival is limited once they develop symptoms from AS and survival after the onset of a symptom depends on what type of symptom a patient develops. Knowing how the pathophysiology of AS causes typical symptoms and death is paramount to understanding the disease. We discuss these issues in this review.

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Coronary Microvascular Dysfunction as a Mechanism of Angina in Severe AS

Abstract: NCT02575768.

Cited by 53 publications

References 38 publications

Determinants and Prognostic Significance of Symptomatic Status in Patients with Moderately Dysfunctional Bicuspid Aortic Valves

Determinants and Prognostic Significance of Symptomatic Status in Patients with Moderately Dysfunctional Bicuspid Aortic Valves

Cardiac magnetic resonance imaging for the assessment of aortic stenosis

Symptomatic presentations of severe aortic stenosis

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