Skip to main content
SpringerLink
Log in

Is the coronary flow velocity reserve improvement after aortic valve replacement for aortic stenosis transient? Results of a 3-year follow-up

  • ORIGINAL ARTICLE
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

The coronary flow velocity reserve (CFR) is decreased in patients with aortic valve stenosis (AS). The aim of the present prospective study was to examine the CFR in AS patients with normal epicardial coronary arteries during a 3-year follow-up of aortic valve replacement (AVR). A total of 30 AS patients (17 women and 13 men) were enrolled in this prospective follow-up study; they all had a normal coronary angiogram and underwent dipyridamole stress transesophageal echocardiography (STEE) for CFR measurement before AVR. Nine of them participated in this 3-year follow-up study, and all patients were examined 16 months and 3 years after AVR by STEE. The CFR of AS patients was decreased before AVR. Different extents of diastolic coronary flow velocity reduction (resting and posthyperaemic) were observed resulting in a significant CFR improvement, despite the low number of patients during the 16-month follow-up. A further posthyperemic flow velocity reduction was demonstrated after the 3-yearfollow-up, resulting in a significant CFR impairment. The CFR decreased in 5 cases, but remained practically unchanged in 3 after the first CFR measurement; only the CFR of 1 patient improved minimally. The main finding of the current study is that the CFR improvement 16 months after AVR, which paralleled the regression of the left ventricular hypertrophy, was found to be transient. Coronary flow velocity reserve impairment was demonstrated after the long-term (3-year) follow-up in most of the patients, which could not be explained by extravascular compressive forces.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. S Iliceto V Marangelli C Memmola P Rizzon (1991) ArticleTitleTranesophageal Doppler echocardiography evaluation of coronary blood flow velocity in baseline conditions and during diypridamole-induced coronary vasodilation Circulation 83 61–69 Occurrence Handle1984899 Occurrence Handle1:STN:280:DyaK3M%2FosV2kuw%3D%3D

    PubMed  CAS  Google Scholar 

  2. S Gadallah KB Thaker D Kawanishi A Mehra S Lau M Rahstian AN Chandraratna (1998) ArticleTitleComparison of intracoronary Doppler guide wire and transesophageal echocardiography in measurement of flow velocity and coronary flow reserve in the left anterior descending coronary artery Am Heart J 135 38–42 Occurrence Handle9453519 Occurrence Handle1:STN:280:DyaK1c7hsValtg%3D%3D Occurrence Handle10.1016/S0002-8703(98)70340-0

    Article  PubMed  CAS  Google Scholar 

  3. BK Julius M Spillmann G Vassalli B Villari FR Eberli OM Hess (1997) ArticleTitleAngina pectoris in patients with aortic stenosis and normal coronary arteries. Mechanisms and pathophysiological concepts Circulation 95 892–898 Occurrence Handle9054747 Occurrence Handle1:STN:280:DyaK2s3gslCmtg%3D%3D

    PubMed  CAS  Google Scholar 

  4. A Nemes T Forster A Varga A Vass A Borthaiser A PÁLINKÁs M Csanády (2002) ArticleTitleHow can coronary flow reserve be altered by severe aortic stenosis? Echocardiography 19 655–659 Occurrence Handle12487634 Occurrence Handle10.1046/j.1540-8175.2002.00655.x

    Article  PubMed  Google Scholar 

  5. K Rajappan OE Rimoldi DP Dutka B Ariff DJ Pennell DJ Sheridan PG Camici (2002) ArticleTitleMechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries Circulation 105 470–476 Occurrence Handle11815430 Occurrence Handle10.1161/hc0402.102931

    Article  PubMed  Google Scholar 

  6. ML Marcus DB Doty LF Hiratzka CB Wright CL Eastham (1982) ArticleTitleDecreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries N Eng J Med 307 1362–1366 Occurrence Handle1:STN:280:DyaL3s%2Fjs1yntg%3D%3D Occurrence Handle10.1056/NEJM198211253072202

    Article  CAS  Google Scholar 

  7. EL Fallen WC Elliott R Gorlin (1967) ArticleTitleMechanisms of angina in aortic stenosis Circulation 36 480–488 Occurrence Handle6041860 Occurrence Handle1:STN:280:DyaF2s3lt1Shsw%3D%3D

    PubMed  CAS  Google Scholar 

  8. R Kawamoto T Imamura K Kawabata H Date T Ishikawa M Maeno T Nagoshi Y Fujiura A Matsuyama T Matsuo Y Koiwaya T Eto (2001) ArticleTitleMicrovascular angina in a patient with aortic stenosis Jpn Circ J 65 839–841 Occurrence Handle11548887 Occurrence Handle1:STN:280:DC%2BD3MvpvFOlsw%3D%3D Occurrence Handle10.1253/jcj.65.839

    Article  PubMed  CAS  Google Scholar 

  9. T Kume T Akasaka T Kawamoto N Watanabe H Yoshitani M Akiyama Y Koyama Y Neishi N Wada K Yoshida (2004) ArticleTitleMechanism of impaired coronary flow reserve in patients with aortic stenosis: transthoracic Doppler echocardiographic study J Cardiol 43 173–178 Occurrence Handle15125381

    PubMed  Google Scholar 

  10. M Rodstein FD Zeman (1967) ArticleTitleAortic stenosis in the aged. Clinical pathological correlations Am J Med Sci 254 577–584 Occurrence Handle6057068 Occurrence Handle1:STN:280:DyaF1c%2FktlOgsg%3D%3D

    PubMed  CAS  Google Scholar 

  11. ER Mohler MJ Sheridan R Nichols WP Harvey BF Waller (1991) ArticleTitleDevelopment and progression of aortic valve stenosis: atherosclerosis risk factors – a causal relationship? A clinical morphologic study Clin Cardiol 14 995–999 Occurrence Handle1841025 Occurrence Handle1:STN:280:DyaK3s%2FgvFajtg%3D%3D Occurrence Handle10.1002/clc.4960141210

    Article  PubMed  CAS  Google Scholar 

  12. A Nemes T Forster M Csanády (2004) ArticleTitleDecreased aortic distensibility and coronary flow velocity reserve in patients with significant aortic valve stenosis with normal epicardial coronary arteries J Heart Valve Dis 13 567–573 Occurrence Handle15311862

    PubMed  Google Scholar 

  13. FR Eberli M Ritter J Schwitter A Bortone J Schneider OM Hess HP Krayenbuehl (1991) ArticleTitleCoronary reserve in patients with aortic valve disease before and after successful aortic valve replacement Eur Heart J 12 127–138 Occurrence Handle2044545 Occurrence Handle1:STN:280:DyaK3M3lslSisA%3D%3D

    PubMed  CAS  Google Scholar 

  14. DJ Hildick-Smith LM Shapiro (2000) ArticleTitleCoronary flow reserve improves after aortic valve replacement for aortic stenosis: an adenosine transthoracic echocardiography study J Am Coll Cardiol 36 1889–1896 Occurrence Handle11092661 Occurrence Handle1:CAS:528:DC%2BD3MXhs1Cg Occurrence Handle10.1016/S0735-1097(00)00947-5

    Article  PubMed  CAS  Google Scholar 

  15. A Nemes T Forster Z Kovacs A Thury I Ungi M Csanady (2002) ArticleTitleThe effect of aortic valve replacement on coronary flow reserve in patients with a normal coronary angiogram Herz 27 780–784 Occurrence Handle12574896 Occurrence Handle10.1007/s00059-002-2355-x

    Article  PubMed  Google Scholar 

  16. K Rajappan OE Rimoldi PG Camici NG Bellenger DJ Pennell DJ Sheridan (2003) ArticleTitleFunctional changes in coronary microcirculation after valve replacement in patients with aortic stenosis Circulation 107 3170–3175 Occurrence Handle12796134 Occurrence Handle10.1161/01.CIR.0000074211.28917.31

    Article  PubMed  Google Scholar 

  17. RB Devereux N Reichek (1977) ArticleTitleEchocardiographic determination of left ventricular mass in man: Anatomic validation of the method Circulation 55 613–618 Occurrence Handle138494 Occurrence Handle1:STN:280:DyaE2s7hsVClsQ%3D%3D

    PubMed  CAS  Google Scholar 

  18. RB Devereux (1987) ArticleTitleDetection of left ventricular hypertrophy by M-mode echocardiography. Anatomic validation, standardization, and comparison to other methods Hypertension 9 IssueID2 Pt 2 II19–II26 Occurrence Handle2948914 Occurrence Handle1:STN:280:DyaL2s7gslyiuw%3D%3D

    PubMed  CAS  Google Scholar 

  19. LE Teichholz MV Cohen EH Sonnenblick R Gorlin (1974) ArticleTitleStudy of the left ventricular geometry and function by B-scan ultrasonography in patients with and without asynergy N Eng J Med 291 1220–1226 Occurrence Handle1:STN:280:DyaE2M%2FjsFGjug%3D%3D Occurrence Handle10.1056/NEJM197412052912304

    Article  CAS  Google Scholar 

  20. M Kupari KS Virtanen H Turto M Viitasalo M Manttari M Lindroos E Koskela H Leinonen S Pohjola-Sintonen J Heikkila (1992) ArticleTitleExclusion of coronary artery disease by exercise thallium-201 tomography in patients with aortic valve stenosis Am J Cardiol 70 635–640 Occurrence Handle1510012 Occurrence Handle1:STN:280:DyaK38znslOjtQ%3D%3D Occurrence Handle10.1016/0002-9149(92)90204-C

    Article  PubMed  CAS  Google Scholar 

  21. S Scheler W Motz BE Strauer (1989) ArticleTitleTransient myocardial ischemia in hypertensive patients Z Kardiol 78 197–203 Occurrence Handle2523620 Occurrence Handle1:STN:280:DyaL1M3isVGgtA%3D%3D

    PubMed  CAS  Google Scholar 

  22. A Nemes T Forster A Thury Z Kovacs K Boda M Csanady (2003) ArticleTitleThe comparative value of the aortic atherosclerosis and the coronary flow velocity reserve evaluated by stress transesophageal echocardiography in the prediction of patients with aortic stenosis with coronary artery disease Int J Cardiac Imag 19 371–376 Occurrence Handle10.1023/A:1025829925910

    Article  Google Scholar 

  23. DB Doty CL Eastham LF Hiratzka CB Wright ML Marcus (1982) ArticleTitleDetermination of coronary reserve in patients with supravalvular aortic stenosis Circulation 66 IssueID2 Pt 2 I186–I192 Occurrence Handle7083541 Occurrence Handle1:STN:280:DyaL383gvFWjtw%3D%3D

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Medicine and Cardiology Centre, Albert Szent-Györgyi Medical and Pharmaceutical Centre, Medical Faculty, University of Szeged, POB 427, H-6701, Szeged, Hungary

    Attila Nemes, Tamás Forster, Zsolt Kovács & Miklós Csanády

Authors
  1. Attila Nemes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamás Forster
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zsolt Kovács
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miklós Csanády
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Attila Nemes.

Additional information

The topic of this paper was presented at the European Society of Cardiology Congress 2004, Munich, Germany

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nemes, A., Forster, T., Kovács, Z. et al. Is the coronary flow velocity reserve improvement after aortic valve replacement for aortic stenosis transient? Results of a 3-year follow-up. Heart Vessels 21, 157–161 (2006). https://doi.org/10.1007/s00380-005-0883-z

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-005-0883-z

Key words

Search

Navigation