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. 1994 Jan;71(1):57–62. doi: 10.1136/hrt.71.1.57

Profiles of coronary blood flow velocity in patients with aortic stenosis and the effect of valve replacement: a transthoracic echocardiographic study.

A Kenny 1, C R Wisbey 1, L M Shapiro 1
PMCID: PMC483612  PMID: 8297696

Abstract

OBJECTIVE--To report the first non-invasive assessment by transthoracic Doppler echocardiography of coronary blood flow in patients with aortic stenosis and of the effects of valve replacement. DESIGN--High frequency transthoracic Doppler echocardiography was used to examine resting phasic flow in the left anterior descending coronary artery before and after replacement of the aortic valve in awake, unsedated patients with pure aortic stenosis and normal coronary arteries. SETTING--A tertiary referral cardiothoracic centre. METHODS--Eleven patients with pure aortic stenosis and normal coronary arteries (six men, five women, mean (range) age 69 (50-82) years), were studied the day before and 1 week after replacement of the aortic valve. These patients were selected from a cohort of 15 due to ease of imaging of the left anterior descending coronary artery. Seven had a history of angina. Haemodynamics, peak transvalvar aortic gradient, left ventricular mass index, ventricular dimensions, and profiles of coronary flow velocity were measured. Profiles of coronary flow velocity were also measured in a control population of 10 normal subjects (five men, five women, mean (range) age 58 (34-66) years). RESULTS--The control population showed forward flow throughout systole, but reversed early systolic flow (mean velocity 20.6 (3.6) cm/s) was seen in six patients with aortic stenosis. Only three of these patients had a clinical history of angina. Peak and mean systolic and diastolic forward flow velocities were not significantly different in the control group and in patients with aortic stenosis. The time from the start of systole to the onset of forward systolic flow was significantly longer in patients with aortic stenosis than in the control population (185 (8.5) v 85 (10) ms, p < 0.01). The time from the onset of diastolic flow to peak diastolic velocity was also significantly longer in the aortic stenosis group (146 (16) v 74 (13) ms, p < 0.01). These abnormalities in profiles of coronary flow were reversed by replacement of the aortic valve. There was no correlation between changes in flow profiles in patients with aortic stenosis and preoperative clinical history, transvalvar gradient, left ventricular mass index, or ventricular dimensions. CONCLUSIONS--Coronary flow profiles in patients with aortic stenosis were characterised by reversed early systolic flow and delayed forward systolic flow and attainment of peak diastolic velocity. Reversal of these abnormalities by replacement of the aortic valve may reflect altered left ventricular and aortic haemodynamics and contribute to the relief of angina when left ventricular hypertrophy persists. Further studies may correlate abnormalities of coronary flow with preoperative clinical and haemodynamic state.

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Selected References

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  1. Basta L. L., Raines D., Najjar S., Kioschos J. M. Clinical, haemodynamic, and coronary angiographic correlates of angina pectoris in patients with severe aortic valve disease. Br Heart J. 1975 Feb;37(2):150–157. doi: 10.1136/hrt.37.2.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Carroll R. J., Falsetti H. L. Retrograde coronary artery flow in aortic valve disease. Circulation. 1976 Sep;54(3):494–499. doi: 10.1161/01.cir.54.3.494. [DOI] [PubMed] [Google Scholar]
  3. Devereux R. B., Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977 Apr;55(4):613–618. doi: 10.1161/01.cir.55.4.613. [DOI] [PubMed] [Google Scholar]
  4. Fallen E. L., Elliott W. C., Gorlin R. Mechanisms of angina in aortic stenosis. Circulation. 1967 Oct;36(4):480–488. doi: 10.1161/01.cir.36.4.480. [DOI] [PubMed] [Google Scholar]
  5. Falsetti H. L., Verani M. S., Cramer J. A., Carroll R. Total, phasic, and regional myocardial blood flow in aortic stenosis. Am Heart J. 1979 Sep;98(3):331–338. doi: 10.1016/0002-8703(79)90045-0. [DOI] [PubMed] [Google Scholar]
  6. Feinstein A. R. T. Duckett Jones Memorial Lecture. The Jones criteria and the challenges of clinimetrics. Circulation. 1982 Jul;66(1):1–5. doi: 10.1161/01.cir.66.1.1. [DOI] [PubMed] [Google Scholar]
  7. Fujiwara T., Nogami A., Masaki H., Yamane H., Matsuoka S., Yoshida H., Fukuda H., Katsumura T., Kajiya F. Coronary flow velocity waveforms in aortic stenosis and the effects of valve replacement. Ann Thorac Surg. 1989 Oct;48(4):518–522. doi: 10.1016/s0003-4975(10)66853-1. [DOI] [PubMed] [Google Scholar]
  8. Graboys T. B., Cohn P. F. The prevalence of angina pectoris and abnormal coronary arteriograms in severe aortic valvular disease. Am Heart J. 1977 Jun;93(6):683–686. doi: 10.1016/s0002-8703(77)80062-8. [DOI] [PubMed] [Google Scholar]
  9. Griggs D. M., Jr, Chen C. C., Tchokoev V. V. Subendocardial anaerobic metabolism in experimental aortic stenosis. Am J Physiol. 1973 Mar;224(3):607–612. doi: 10.1152/ajplegacy.1973.224.3.607. [DOI] [PubMed] [Google Scholar]
  10. Johnson L. L., Sciacca R. R., Ellis K., Weiss M. B., Cannon P. J. Reduced left ventricular myocardial blood flow per unit mass in aortic stenosis. Circulation. 1978 Mar;57(3):582–590. doi: 10.1161/01.cir.57.3.582. [DOI] [PubMed] [Google Scholar]
  11. Kenny A., Shapiro L. M. Transthoracic high-frequency two-dimensional echocardiography, Doppler and color flow mapping to determine anatomy and blood flow patterns in the distal left anterior descending coronary artery. Am J Cardiol. 1992 May 15;69(16):1265–1268. doi: 10.1016/0002-9149(92)91218-s. [DOI] [PubMed] [Google Scholar]
  12. Marcus M. L., Doty D. B., Hiratzka L. F., Wright C. B., Eastham C. L. Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med. 1982 Nov 25;307(22):1362–1366. doi: 10.1056/NEJM198211253072202. [DOI] [PubMed] [Google Scholar]
  13. Matsuo S., Tsuruta M., Hayano M., Imamura Y., Eguchi Y., Tokushima T., Tsuji S. Phasic coronary artery flow velocity determined by Doppler flowmeter catheter in aortic stenosis and aortic regurgitation. Am J Cardiol. 1988 Nov 1;62(13):917–922. doi: 10.1016/0002-9149(88)90893-4. [DOI] [PubMed] [Google Scholar]
  14. Pichard A. D., Gorlin R., Smith H., Ambrose J., Meller J. Coronary flow studies in patients with left ventricular hypertrophy of the hypertensive type. Evidence for an impaired coronary vascular reserve. Am J Cardiol. 1981 Mar;47(3):547–554. doi: 10.1016/0002-9149(81)90537-3. [DOI] [PubMed] [Google Scholar]
  15. Pyle R. L., Lowensohn H. S., Khouri E. M., Gregg D. E., Patterson D. F. Left circumflex coronary artery hemodynamics in conscious dogs with congenital subaortic stenosis. Circ Res. 1973 Jul;33(1):34–38. doi: 10.1161/01.res.33.1.34. [DOI] [PubMed] [Google Scholar]
  16. ROWE G. G., AFONSO S., LUGO J. E., CASTILLO C. A., BOAKE W. C., CRUMPTON C. W. CORONARY BLOOD FLOW AND MYOCARDIAL OXIDATIVE METABOLISM AT REST AND DURING EXERCISE IN SUBJECTS WITH SEVERE AORTIC VALVE DISEASE. Circulation. 1965 Aug;32:251–257. doi: 10.1161/01.cir.32.2.251. [DOI] [PubMed] [Google Scholar]
  17. Ross J. J., Jr, Mintz G. S., Chandrasekaran K. Transthoracic two-dimensional high frequency (7.5 MHz) ultrasonic visualization of the distal left anterior descending coronary artery. J Am Coll Cardiol. 1990 Feb;15(2):373–377. doi: 10.1016/s0735-1097(10)80065-8. [DOI] [PubMed] [Google Scholar]
  18. Ross J. J., Jr, Ren J. F., Land W., Chandrasekaran K., Mintz G. S. Transthoracic high frequency (7.5 MHz) echocardiographic assessment of coronary vascular reserve and its relation to left ventricular mass. J Am Coll Cardiol. 1990 Nov;16(6):1393–1397. doi: 10.1016/0735-1097(90)90382-y. [DOI] [PubMed] [Google Scholar]
  19. Sabbah H. N., Stein P. D. Reduction of systolic coronary blood flow in experimental left ventricular outflow tract obstruction. Am Heart J. 1988 Sep;116(3):806–811. doi: 10.1016/0002-8703(88)90341-9. [DOI] [PubMed] [Google Scholar]
  20. Strauer B. E. Ventricular function and coronary hemodynamics in hypertensive heart disease. Am J Cardiol. 1979 Oct 22;44(5):999–1006. doi: 10.1016/0002-9149(79)90235-2. [DOI] [PubMed] [Google Scholar]
  21. Vinten-Johansen J., Weiss H. R. Oxygen consumption in subepicardial and subendocardial regions of the canine left ventricle. The effect of experimental acute valvular aortic stenosis. Circ Res. 1980 Jan;46(1):139–145. doi: 10.1161/01.res.46.1.139. [DOI] [PubMed] [Google Scholar]
  22. WOOD P. Aortic stenosis. Am J Cardiol. 1958 May;1(5):553–571. doi: 10.1016/0002-9149(58)90138-3. [DOI] [PubMed] [Google Scholar]

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