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Coronary microvascular dysfunction, left ventricular remodeling, and clinical outcomes in aortic stenosis



We investigated role of coronary microvascular disease (CMD) in maladaptive LV remodeling and prognosis in patients with aortic sclerosis or stenosis and no overt CAD.


This was a retrospective cohort study of patients with aortic sclerosis or stenosis, normal myocardial perfusion and LV ejection fraction (EF) > 50% (n = 43) and matched controls without AS (n = 43). PET and echocardiograms were performed within 1 year of each other. Myocardial perfusion and myocardial flow reserve (MFR) were quantified using PET imaging. LV structure and function, including global longitudinal strain (GLS), were quantified by transthoracic echocardiography.


Global MFR declined with increasing AS severity (P = 0.04). Probability of impaired MFR increased with severity of adverse LV remodeling (OR 1.88, CI 1.03 to 3.41, P =0.04). Reduced MFR associated with impaired GLS (r = − 0.29, P = 0.002) and associated with reduced MACE-free survival at 7.27 years median follow-up. Adjusted annualized rate of MACE was highest in those with impaired GLS and MFR and lowest in those with normal GLS and MFR (30.99% vs 1.86%, P =0.002).

Conclusion and Relevance

In patients with AS and no overt CAD, impaired MFR associates with adverse LV remodeling and subclinical LV mechanical dysfunction, and is a marker increased clinical risk.

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Figure 1
Figure 2



Aortic stenosis


Aortic valve replacement


Coronary microvascular dysfunction


Global longitudinal strain


Left ventricular hypertrophy


Myocardial blood flow


Myocardial flow reserve


Positron emission tomography


Summed stress score


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Dr. Dorbala is a member of an advisory board for General Electric Health Care. Dr. Di Carli has received consulting fees from Sanofi and General Electric. Dr. Kaneko has served as a proctor and speaker for Edwards Lifesciences, Abbot and Medtronic. Dr. Shah has served as a proctor and educator for Edwards Lifesciences and educator for St. Jude Medical. All other authors have no disclosures to report.

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Correspondence to Marcelo Di Carli MD.

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This was supported by National Institutes of Health Grant Numbers 5T32HL094301 to Drs. Zhou, Bajaj, Gupta, Divakaran; K23HL135438 to Dr. Taqueti; and R01HL132021 to Dr. Di Carli.

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Zhou, W., Bajaj, N., Gupta, A. et al. Coronary microvascular dysfunction, left ventricular remodeling, and clinical outcomes in aortic stenosis. J. Nucl. Cardiol. 28, 579–588 (2021).

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  • PET
  • modalities
  • echo
  • myocardial blood flow
  • tests