title: Coronary flow reserve is impaired in patients with aortic valve calcification.
abstract: BACKGROUND
  Calcific aortic valve disease is an active and progressive condition. Data indicate that aortic valve calcification (AVC) is associated with endothelial dysfunction and accepted as a manifestation of atherosclerosis. Coronary flow reserve (CFR) determined by transthoracic echocardiography has been introduced as a reliable indicator for coronary microvascular function. In this study we aimed to evaluate CFR in patients with AVC.
  
  
  METHODS
  Eighty patients, aged more than 60 years, without coronary heart disease or diabetes mellitus were included: 40 had AVC without significant stenosis (peak gradient across the valve <25 mm Hg) and 40 had normal aortic valves (controls). Using transthoracic Doppler echocardiography, we measured coronary diastolic peak flow velocities (PFV) at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic PFV and was compared between groups.
  
  
  RESULTS
  Mean ages for patients with AVC and controls were 68.9+/-6.2 and 67.6+/-5.9 years (P=.3). There were no significant differences regarding clinical characteristics, laboratory findings, ejection fraction, or peak aortic valve gradients. Mean diastolic PFV at baseline and during hyperemia were 28.4+/-4.2 and 59.2+/-7.8 cm/s for AVC and 27.7+/-3.9 and 68.5+/-10.5 cm/s for controls. Compared with controls, patients with AVC had significantly lower CFR values (2.12+/-0.41 versus 2.51+/-0.51; P<.0001).
  
  
  CONCLUSIONS
  CFR is impaired in patients with AVC before valve stenosis develops, suggesting that microvascular-endothelial dysfunction is present during the early stages of the calcific aortic valve disease.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Baskent University, Ankara, Turkey. hbozbas@gmail.com
authors.forename: Huseyin
authors.initials: H
authors.lastname: Bozbas
authors.forename: Bahar
authors.initials: B
authors.lastname: Pirat
authors.forename: Aylin
authors.initials: A
authors.lastname: Yildirir
authors.forename: Vahide
authors.initials: V
authors.lastname: Simşek
authors.forename: Elif
authors.initials: E
authors.lastname: Sade
authors.forename: Serpil
authors.initials: S
authors.lastname: Eroglu
authors.forename: Ilyas
authors.initials: I
authors.lastname: Atar
authors.forename: Cihan
authors.initials: C
authors.lastname: Altin
authors.forename: Saadet
authors.initials: S
authors.lastname: Demirtas
authors.forename: Bulent
authors.initials: B
authors.lastname: Ozin
authors.forename: Haldun
authors.initials: H
authors.lastname: Muderrisoglu
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D050197:Atherosclerosis / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005080:Exercise Test / Q000379:methods; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged