title: Functional changes in coronary microcirculation after valve replacement in patients with aortic stenosis.
abstract: BACKGROUND
  Increased extravascular compression and reduced diastolic perfusion time (DPT), rather than vascular remodeling, influence coronary microcirculatory dysfunction in aortic stenosis (AS). However, alterations after aortic valve replacement (AVR) remain unclear. The aim of the present study was to quantify changes in transmural perfusion and coronary vasodilator reserve (CVR), a measure of microcirculatory function, after AVR and determine the relative contribution of left ventricular mass (LVM) regression, change in aortic valve area (AVA), and DPT.
  
  
  RESULTS
  Twenty-two patients with AS were studied before and 1 year after AVR using echocardiography to measure AVA, cardiovascular magnetic resonance to assess LVM, and positron emission tomography to quantify resting and hyperemic myocardial blood flow (MBF) and CVR. Regression of LVM occurred in all patients (from 129+/-30 to 94+/-24 g/m2; P<0.0001), and there was a significant reduction in resting MBF and increase in CVR corrected for rate-pressure product after AVR, although these changes displayed marked heterogeneity. Regression of LVM was linearly related to change in resting total LV blood flow but not CVR. Increase in hyperemic MBF and CVR transmurally was directly related to the increase in AVA after AVR. A significant relationship existed between the change in hyperemic DPT (1.0+/-4.7 s/min [range, 6.8 to 9.6]) and change in transmural CVR (y=0.08x+0.18; r=0.44; P=0.04).
  
  
  CONCLUSIONS
  Changes in coronary microcirculatory function in patients with AS after AVR are not directly dependent on regression of LVM. Reduced extravascular compression and increased DPT are proposed as the main mechanisms for improvement in MBF and CVR after AVR.
authors.affiliation: Academic Cardiology Unit, St Mary's Hospital, London, UK.
authors.forename: Kim
authors.initials: K
authors.lastname: Rajappan
authors.forename: Ornella E
authors.initials: OE
authors.lastname: Rimoldi
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Camici
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Bellenger
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.forename: Desmond J
authors.initials: DJ
authors.lastname: Sheridan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D001783:Blood Flow Velocity; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008833:Microcirculation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D012044:Regression Analysis; D012074:Remission Induction; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects