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Pathophysiological and clinical implications of high intramural coronary blood flow velocity in aortic stenosis

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Abstract

We sought to recognize the blood flow velocity (BFV) through the left anterior descending (LAD) coronary artery and its small intramyocardial (IM) branches by transthoracic Doppler-echocardiography in patients with aortic stenosis (AS). Sixty-two patients, aged 74.0 ± 9.6 years, 37 women, with preserved left ventricular (LV) function, apparently free of active ischemic disease, were enrolled and classified into 3 groups according to the mean gradient (MG) across the aortic valve: 13 patients (21%) entered the group A (MG ≤ 20 mmHg), 29 (48%) group B (MG 21–40 mmHg) and 20 (31%) group C (MG > 40 mmHg). Peak and mean coronary BFVs were demonstrated to gradually increase according to AV gradient, especially through the IM arteries. Peak IM-BFV was 58.9 cm/s (95% CI 46.4–71.4) in group A, 73.2 cm/s (95% CI 64.8–81.6) in group B, and 96.4 cm/s (95% CI 86.3–106.5) in group C (p < 0.001), whereas peak LAD-BFV was 38.1 cm/s (95% CI 32.8–43.3), 44.4 cm/s (95% CI 40.9–47.9) and 47.3 cm/s (95% CI 43.1–52.5), respectively (p = 0.03). Also, 34 patients complaining with unspecific symptoms showed much higher IM-BFV than those who were not. High values were also recognized in patients with LV ejection fraction/velocity ratio (EFVR) ≤ 0.90 (IM-BFV 91 ± 26 cm/s vs. 72 ± 24 cm/s in those with EFVR > 0.90, p = 0.001). In conclusion, AS patients in the present study showed gradually higher coronary BFVs according to AS gradient, especially through the IM vessels, and both peak and mean velocities were discriminating specific patient subsets. Pathophysiological mechanisms and potential clinical implications are discussed.

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*Modified from Treibel et al. [31]

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Acknowledgements

The authors gratefully acknowledge Drs. Francesco Saporito and Giuseppe Andò and the nursing staff of the Cardiac Catheterization Lab of our Cardiology Unit (Messina University Hospital) for their precious collaboration.

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University Hospital of Messina, Via Consolare Valeria, 98125, Messina, Italy

    Cesare de Gregorio, Giuseppe Ferrazzo, Gianluca Di Bella, Matteo Casale, Francesco Arrigo & Scipione Carerj

  2. Department of Emergency. Cardiology Unit, University Hospital of Messina, Via Consolare Valeria, 98125, Messina, Italy

    Cesare de Gregorio, Patrizia Grimaldi, Gianluca Di Bella & Scipione Carerj

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  1. Cesare de Gregorio
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de Gregorio, C., Grimaldi, P., Ferrazzo, G. et al. Pathophysiological and clinical implications of high intramural coronary blood flow velocity in aortic stenosis. Heart Vessels 35, 637–646 (2020). https://doi.org/10.1007/s00380-019-01532-9

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