Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries

Abstract

Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries, International Journal of Cardiology (2017Cardiology ( ), doi:10.1016Cardiology ( /j.ijcard.2017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT Conflicts of interest: None to declareKeywords: Aortic valve calcification score, coronary microvascular dysfunction, calcific aortic valve disease. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 Abstract:Background: Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) -a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation.Methods: 183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay.Results: Mean(±SD) participant age was 59.8(9.6) years. Mean AVCS was 68 (258) Conclusion:Coronary microvascular function as determined by measurement of myocardial blood flow reserve is independently associated with early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation.

Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

“…However, no evidence-based cut-off values for CFR in PET are available yet. Similarly, no cut-off values for CFR in TTE have yet been determined and generally a cut-off value of less than 2.0 for the diagnosis of CMD is applied [18,[45][46][47][48][49]. TTE assessment of CFR with Doppler echocardiography has been validated against intracoronary Doppler measurements and outcomes correlate well [2,5,36,50].…”

“…This is needed to provide clinically applicable, possibly sex-speci c, reference values for the diagnosis of CMD in the future. Furthermore, during this systematic review, we found several other imaging modalities that are studied for their potential to diagnose CMD, such as myocardial contrast echocardiography (MCE) [47,59,60], CT-perfusion [61] and absolute quanti cation of myocardial perfusion by CMR [62]. However, current evidence is still limited so the clinical signi cance and applicability in regular care of these modalities in CMD diagnosis remains unclear.…”