Long‐term prognostic role of coronary flow velocity reserve in patients with aortic valve stenosis – insights from the SZEGED Study

Nemes, Attila; Balázs, Erika; Csanády, Miklós; Forster, Tamás

doi:10.1111/j.1475-097x.2009.00893.x

Cited by 38 publications

(39 citation statements)

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“…The additive prognostic value of simultaneously evaluated CFR and wall motion abnormalities [3,[21][22][23][24], aortic distensibility indices [25], or grade of AA [26] was also demonstrated. Moreover, CFR was found to be predictive for future events in hypertensives [27], AS [6], dilated [28][29][30] and hypertrophic cardiomyopathies [5,31], in renal transplant recipients [32] and after heart transplantation [33], as well. Gender differences [24], and the prognostic value of CFR assessments on both left and right coronary arteries has also been examined [23,30].…”

Section: Discussionmentioning

confidence: 99%

“…From 1997, 540 consecutive patients with suspected CAD, valvular heart disease or cardiomyopathies had undergone CFR measurement to examine its clinical usefulness at the Cardiology Center of University of Szeged. From the SZEGED Study, the independent prognostic value of CFR has been recently demonstrated in hypertrophic cardiomyopathy (HCM) [5], in aortic valve stenosis (AS) [6], in CAD not involving the LAD [7], in female patients with chest pain and negative coronary angiograms [8], and in patients without LAD stenosis [9].…”

Section: Study Populationmentioning

confidence: 99%

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Coronary flow velocity reserve predicts survival in non-diabetic patients

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Coronary flow velocity reserve predicts survival in non-diabetic patients

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“…Poznato je da jedan broj pacijenata sa AS i angiografski normalnim koronarnim arterijama ima smanjenu rezervu koronarnog protoka (CFR) 50,51,121 Najčešće, kod ovih pacijenata, u apsolutnim vrednostima, protok kroz koronarne arterije u miru je povećan, ali je u odnosu na ukupnu masu miokarda protok u donjim granicama normale, ili čak nedovoljan za adekvatno snabdevanje kiseonikom 122 .…”

Section: Uticaj As Na Koronarnu (Mikro) Cirkulacijuunclassified

“…Ova cut-off vrednost je slična uočenoj vrednosti na koju se povećala CFR 6 meseci nakon operacije zamene aortnog zaliska kod pacijenata sa izolovanom AS i preoperativno angiografski normalnim epikardnim koronarnim arterijama 127 . Takođe, prosečna vrednost CFR (2,1) u našoj grupi pacijenata sa CFR ≤ 2,5 odgovara vrednosti CFR koja je u studiji Nemesa i saradnika 50 , koja je ispitivala istu populaciju pacijenata, imala najveću vrednost u predikciji MACE.…”

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The importance of Doppler-echocardiographic parameters of left ventricle for risk stratification and early prognosis in aortic stenosis

Banović¹

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Datum odbrane:Rad na jednoj naučnoj studiji predstavlja sublimaciju vrednovanja naučne ideje, naučne pretrage, naučne saradnje sa kolegama i, konačno, izrade i uobličenja jedne originalne naučne celine.Moj doktorski rad, od ideje koju sam prihvatio kao naučni izazov, preko praktičnog rada sa saradnicima u ehokardiografskom kabinetu i kabinetu za ergospirometriju, uz razumevanje i dobru saradnju sa pacijentima, rezultat je višegodišnjeg pravog i dobrog timskog rada.Posebno izdvajam zahvalnost mom mentoru, Prof. dr Bosiljki Vujisić-Tešić, na velikoj podršci, pomoći, savetima i razumevanju, kao i ukazanom poverenju u mene lično i u ishod ovog rada.Veliku zahvalnost dugujem Svetlani Bojić koja se u potpunosti posvetila statističkoj obradi i koja je i sama ovu doktorsku disertaciju doživela kao izazov.Iskreno se zahvaljujem mojim stalnim saradnicama, medicinskim sestrama, bez čije pomoći rad sa pacijentima, i u okviru toga na ovoj doktorskoj disertaciji, nije bio moguć.Dugujem zahvalnost kolegama sa kardiologije, posebno kolegama sa odseka neinvazivne i invazivne kardiološke dijagnostike, koji su i sami prolazili, prolaze ili će prolaziti kroz ovakve izazove.Zahvaljujem se mojim naučnim saradnicima i kolegama sa "Mayo" klinike (Ročester, USA), na provokativnim razgovorima, razmeni mišljenja i sugestijama, a posebno se zahvaljujem mom dragom prijatelju i učitelju Prof. dr Marc Callahanu. angiogramom. Zbog toga, za očekivati je da bi zamena aortnog zaliska pre pojave simptoma i disfunkcije LK bila od koristi, ali još uvek nema dovoljno urađenih prospektivnih studija koje bi ovu pretpostavku i potvrdile. Najčešće korišćeni Doppler-ehokardiografski parametri, poput srednjeg gradijenta pritiska (P srednje ) i maksimalne brzine protoka (V max ) su neophodni u određivanju težine AS, ali su manje korisni u predikciji ishoda, pojave simptoma i određivanju optimalnog vremena za zamenu zaliska kod asimptomatskih pacijenata. Novi ehokardiografski parametri, poput valvulo-arterijalne impedance (Z va ), i indeksa gubitka energije (ELI) su predloženi kao alternativa, ali još uvek nema dovoljno longitudinalnih-prospektivnih studija koje bi potvrdile njihovu korisnost. Primena dobutaminskog testa (DSE) u asimptomatskoj AS je obećavajuća, s obzirom na činjenicu da je većina Doppler-ehokardiografskih parametara koji se koriste u proceni AS zavisna od količine protoka preko aortne valvule. Farmakološki indukovano povećanje protoka moglo bi biti od pomoći u utvrđivanju težine AS, otkrivanju latentnih simptoma, proceni funkcije sistolne funkcije LK kod pacijenata sa očuvanom ejekcionom frakcijom u miru (EF) i, najvažnije, donošenju optimalnih kliničkih odluka.Ciljevi ove doktorske disertacije bili su da se definišu ehokardiografski parametri koji mogu da indentifikuju pacijente sa povećanim rizikom da dobiju neželjeni kardiovaskularni događaj u jednogodišnjem vremenskom intervalu, kao i da se utvrdi prediktivni značaj promene sistolnih i dijastolnih parametara LK tokom DSE testa kod asimptomatskih pacijenata sa umerenom i tesnom AS i očuv...

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Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation

et al. 2023

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AimsIn patients with aortic stenosis (AS), the coronary flow reserve decreases even in the absence of epicardial coronary artery stenosis. Systolic coronary flow reversal (SFR) reflecting reduced coronary microcirculation, often seen in patients with severe AS, has a potential negative impact on the pathogenesis of cardiac dysfunction. However, there are limited data on the relationship between the severity of AS and SFR, as well as on the benefits of transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the relationship between the severity of AS and efficacy of TAVI in improving SFR. Methods and resultsConsecutive patients with AS who had undergone TAVI using transoesophageal echocardiography (TEE) from November 2020 to February 2022 were prospectively enrolled. Coronary flow in the left anterior descending artery as well as the aortic valve peak velocities, and the mean aortic valve pressure gradients (AVPGs), indicating the severity of AS, were measured using intraprocedural TEE before and after TAVI. The following parameters were measured as coronary flow: systolic and diastolic peak velocity (cm/s) and systolic and diastolic velocity-time integral (VTI) (cm). SFR was defined as the presence of a reversal coronary flow component in systole. The enrolled patients were classified into two groups according to the presence or absence of SFR before TAVI. A total of 25 patients were included: 13 had SFR and 12 who had no SFR, before TAVI. Patients with SFR had significantly higher aortic valve peak velocities (451.1 ± 45.9 vs. 372.1 ± 52.1 cm/s; P < 0.001) and mean AVPGs (49.2 ± 14.5 vs. 30.3 ± 11.6 mmHg; P = 0.002) than those without. The optimal binary cut-off aortic valve peak velocity values and the mean AVPG associated with the presence of SFR before TAVI were >410.0 cm/s (specificity, 75.0%; sensitivity, 92.3%) and >37.4 mmHg (specificity, 83.3%; sensitivity, 92.3%), respectively. After TAVI, SFR immediately disappeared in 11 of 13 patients with SFR (84.6%). Overall, the systolic coronary VTI significantly increased after TAVI (2.0 ± 4.7 vs. 6.4 ± 3.2 cm, P < 0.001), and this increase was greater in patients with SFR than in those without SFR before TAVI (interaction P = 0.035). Conclusions SFR was found to be associated with the severity of AS and with a greater increase in systolic coronary flow immediately after TAVI.

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Long‐term prognostic role of coronary flow velocity reserve in patients with aortic valve stenosis – insights from the SZEGED Study

Cited by 38 publications

References 35 publications

Coronary flow velocity reserve predicts survival in non-diabetic patients

Coronary flow velocity reserve predicts survival in non-diabetic patients

The importance of Doppler-echocardiographic parameters of left ventricle for risk stratification and early prognosis in aortic stenosis

Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation

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