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

Abstract

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.

Comparison of Coronary Artery Diameter in Patients with Chronic Aortic Regurgitation or Stenosis

“…These hemodynamic factors might explain differences between AR and AS groups. [26] The present study has several limitations, which may affect the assessment. First, it was an observational, single-center, cross-sectional study.…”

Simple interrupted suturing for aortic valve replacement in a small aortic annulus

“…With regard to the formula with which the index was calculated, we disagree with the use of the mere diastolic BP (DBP) and systolic BP (SBP) without taking into consideration the BP amplitude (pulse pressure). 2 A closer look at the original article's Figure E2, which shows that DBP alone does not correlate with relevant PAR, confirms this assumption. Because we intended to calculate the influence of BP amplitude before and after valve implantation, both the SBP and the DBP were noted at those different time points (1 and 3 in equation).…”

“…We call this an en bloc stitch. 2 The leaflet attachment, which is the subvalvular rolling tissue in ventricular pledgeted mattress suturing, is buried in the sutures. The outer margin of the sewing ring is located at the transition of the muscular tissue and the connective tissue in the sinus wall, and we can place as large a prosthesis as necessary.…”

Blood biomarkers in patients with bicuspid aortic valve disease

“…Although we did not find an association between hsTnT levels and LVEF, we did find that hsTnT levels were associated with more severe aortic valve regurgitation in BAV patients. One hypothetical explanation might be the reduced coronary blood flow during diastole found in patients with aortic regurgitation [34,35], which can result in cardiomyocyte damage and therefore increased hsTnT levels. A reduced coronary blood flow is also found in patients with aortic stenosis [36], while aortic stenosis was not associated with increased hsTnT levels in our cohort.…”