title: Coronary Physiology During Exercise and Vasodilation in the Healthy Heart and in Severe Aortic Stenosis.
abstract: Severe aortic stenosis (AS) can manifest as exertional angina even in the presence of unobstructed coronary arteries.
  
  
  
  The authors describe coronary physiological changes during exercise and hyperemia in the healthy heart and in patients with severe AS.
  
  
  
  Simultaneous intracoronary pressure and flow velocity recordings were made in unobstructed coronary arteries of 22 patients with severe AS (mean effective orifice area 0.7 cm(2)) and 38 controls, at rest, during supine bicycle exercise, and during hyperemia. Stress echocardiography was performed to estimate myocardial work. Wave intensity analysis was used to quantify waves that accelerate and decelerate coronary blood flow (CBF).
  
  
  
  Despite a greater myocardial workload in AS patients compared with controls at rest (12,721 vs. 9,707 mm Hg/min(-1); p = 0.003) and during exercise (27,467 vs. 20,841 mm Hg/min(-1); p = 0.02), CBF was similar in both groups. Hyperemic CBF was less in AS compared with controls (2,170 vs. 2,716 cm/min(-1); p = 0.05). Diastolic time fraction was greater in AS compared with controls, but minimum microvascular resistance was similar. With exercise and hyperemia, efficiency of perfusion improved in the healthy heart, demonstrated by an increase in the relative contribution of accelerating waves. By contrast, in AS, perfusion efficiency decreased due to augmentation of early systolic deceleration and an attenuated rise in systolic acceleration waves.
  
  
  
  Invasive coronary physiological evaluation can be safely performed during exercise and hyperemia in patients with severe aortic stenosis. Ischemia in AS is not related to microvascular disease; rather, it is driven by abnormal cardiac-coronary coupling.
authors: British Heart Foundation Centre of Excellence and National Institute for Health, Biomedical Research Centre, Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, United Kingdom.
authors: Matthew
authors: M
authors: Lumley
authors: British Heart Foundation Centre of Excellence and National Institute for Health, Biomedical Research Centre, Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, United Kingdom.
authors: Rupert
authors: R
authors: Williams
authors: British Heart Foundation Centre of Excellence and National Institute for Health, Biomedical Research Centre, Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, United Kingdom.
authors: Kaleab N
authors: KN
authors: Asrress
authors: British Heart Foundation Centre of Excellence and National Institute for Health, Biomedical Research Centre, Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, United Kingdom.
authors: Satpal
authors: S
authors: Arri
authors: British Heart Foundation Centre of Excellence and National Institute for Health, Biomedical Research Centre, Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, United Kingdom.
authors: Natalia
authors: N
authors: Briceno
authors: British Heart Foundation Centre of Excellence and National Institute for Health, Biomedical Research Centre, Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, United Kingdom.
authors: Howard
authors: H
authors: Ellis
authors: Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors: Ronak
authors: R
authors: Rajani
authors: Department of Biomedical Engineering, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Maria
authors: M
authors: Siebes
authors: Heart Centre, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Jan J
authors: JJ
authors: Piek
authors: Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors: Brian
authors: B
authors: Clapp
authors: British Heart Foundation Centre of Excellence and National Institute for Health, Biomedical Research Centre, Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors: Simon R
authors: SR
authors: Redwood
authors: British Heart Foundation Centre of Excellence and National Institute for Health, Biomedical Research Centre, Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, United Kingdom.
authors: Michael S
authors: MS
authors: Marber
authors: Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors: John B
authors: JB
authors: Chambers
authors: British Heart Foundation Centre of Excellence and National Institute for Health, Biomedical Research Centre, Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: Divaka.Perera@kcl.ac.uk.
authors: Divaka
authors: D
authors: Perera
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D025401:Echocardiography, Stress; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology*; D012720:Severity of Illness Index; D014655:Vascular Resistance; D014664:Vasodilation / Q000502:physiology*
keywords: coronary blood flow; microvascular resistance; velocity; wave intensity analysis