Coronary blood flow in patients with severe aortic stenosis before and after transcatheter aortic valve implantation

Itsik Ben-Dor, Rahul Malik, Sa'ar Minha, Steven A. Goldstein, Zuyue Wang, Marco A. Magalhaes, Gaby Weissman, Petros G. Okubagzi, Rebecca Torguson, Joseph Lindsay, Lowell F. Satler, Augusto D. Pichard, Ron Waksman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Patients with severe aortic stenosis and no obstructed coronary arteries are reported to have reduced coronary fl ow. Doppler evaluation of proximal coronary flow is feasible using transesophageal echocardiography. The present study aimed to assess the change in coronary flow in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The left main coronary artery was visualized using transesophageal echocardiography in 90 patients undergoing TAVI using the Edwards SAPIEN valve. The peak systolic and diastolic velocities of the coronary flow and the time-velocity integral were obtained before and after TAVI using pulse-wave Doppler. Mean aortic gradients decreased from 47.1 ± 15.7 mm Hg before TAVI to 3.6 ± 2.6 mm Hg after TAVI (p <0.001). The aortic valve area increased from 0.58 ± 0.17 to 1.99 ± 0.35 cm2 (p <0.001). The cardiac output increased from 3.4 ± 1.1 to 3.8 ± 1.0 L/min (p <0.001). Left ventricular end-diastolic pressure (LVEDP) decreased from 19.8 ± 5.4 to 17.3 ± 4.1 mm Hg (p <0.001). The following coronary flow parameters increased significantly after TAVI: peak systolic velocity 24.2 ± 9.3 to 30.5 ± 14.9 cm/s (p <0.001), peak diastolic velocity 49.8 ± 16.9 to 53.7 ± 22.3 cm/s (p = 0.04), total velocity-time integral 26.7 ± 10.5 to 29.7 ± 14.1 cm (p = 0.002), and systolic velocity-time integral 6.1 ± 3.7 to 7.7 ± 5.0 cm (p = 0.001). Diastolic time-velocity integral increased from 20.6 ± 8.7 to 22.0 ± 10.1 cm (p = 0.04). Total velocity-time integral increased >10% in 43 patients (47.2%). Pearson's correlation coef ficient revealed the change in LVEDP as the best correlate of change in coronary flow (R = -0.41, p = 0.003). In conclusion, TAVI resulted in a signifi cant increase in coronary flow. The change in coronary flow was associated mostly with a decrease in LVEDP.

Original languageEnglish
Pages (from-to)1264-1268
Number of pages5
JournalAmerican Journal of Cardiology
Issue number8
StatePublished - 15 Oct 2014
Externally publishedYes


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