Coronary flow reserve is impaired in patients with aortic valve calcification.
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.
Bozbas
Huseyin
H
Department of Cardiology, Faculty of Medicine, Baskent University, Ankara, Turkey. hbozbas@gmail.com
Pirat
Bahar
B
Yildirir
Aylin
A
Simşek
Vahide
V
Sade
Elif
E
Eroglu
Serpil
S
Atar
Ilyas
I
Altin
Cihan
C
Demirtas
Saadet
S
Ozin
Bulent
B
Muderrisoglu
Haldun
H
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