Valvular & structural heart disease
Characterisation of coronary microvascular dysfunction in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI)
Authors' conclusion
In this observational, hypothesis-generating study, CMD was associated with extravalvular cardiac damage and a low-flow phenotype in patients with severe AS undergoing TAVI.
Study context
- Population
- Patients with severe aortic stenosis (AS) undergoing TAVI
- Participants
- 134 patients
- Exposure
- Low microvascular resistance reserve (MRR) vs higher MRR; advanced extravalvular cardiac damage (EVCD) and LF LG-AS vs not
- Outcome
- Association of MRR (invasive thermodilution, LAD) with adverse cardiac remodelling, low-flow phenotype and EVCD; CMD = lowest MRR tertile
Methodological detailsmulticentre, observational, hypothesis-generating
- Multicentre
- Observational
- Hypothesis-generating
Main finding
As reported in the abstract
MRR · baseline
Advanced EVCD
1.80
median · range 1.26–3.30
No advanced EVCD
2.50
median · range 1.87–3.41
LF LG-AS
1.85
median · range 1.20–3.04
No LF LG-AS
2.50
median · range 1.87–3.40
Adjusted odds ratio (CI)P value
Advanced EVCD
3.08(1.22–7.76)
P = 0.017Low-flow phenotype
3.36(1.08–10.47)
P = 0.036Observational data: associations, not effects.
Further findings
Characteristics of low-MRR patients
- More often female, lower eGFR, higher rate of AF
MRR change after TAVI · immediately after TAVI
- MRR significantly impaired after TAVI
- 38 (28.4%)
- Microvascular function tended to improve overall; MRR increased significantly in low-baseline-MRR subgroup
Original publication
Characterisation of coronary microvascular dysfunction in patients with severe aortic stenosis undergoing TAVI. EuroIntervention. Published 4 March 2024. doi:10.
Summarised from the published abstract; every number is checked against it