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Regression of left ventricular hypertrophy provides an additive physiological benefit following treatment of aortic stenosis: insights from serial coronary wave-intensity analysis

Broyd, CJ; Rigo, F; Nijjer, S; Sen, S; Petraco, R; Al-Lamee, R; Foin, N; ... Davies, JE; + view all (2018) Regression of left ventricular hypertrophy provides an additive physiological benefit following treatment of aortic stenosis: insights from serial coronary wave-intensity analysis. Acta Physiologica , 224 (4) , Article e13109. 10.1111/apha.13109. Green open access

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Abstract

AIM: Severe aortic stenosis frequently involves the development of left ventricular hypertrophy (LVH) creating a dichotomous hemodynamic state within the coronary circulation. Whilst the increased force of ventricular contraction enhances its resultant relaxation and thus increases the distal diastolic coronary 'suction' force, the presence of LVH has a potentially opposing effect on ventricular-coronary interplay. The aim of this study was to use non-invasive coronary wave-intensity analysis (WIA) to separate and measure the sequential effects of outflow-tract obstruction relief and then left ventricular hypertrophy (LVH) regression following intervention for aortic stenosis. METHODS: 15 patients with unobstructed coronary arteries undergoing aortic valve intervention (11 SAVR, 4 TAVI) were successfully assessed before and after intervention, and at 6- and 12-months post-procedure. Coronary WIA was constructed from simultaneously acquired coronary flow from transthoracic echo and pressure from an oscillometric brachial-cuff system. RESULTS: Immediately following intervention, a decline in the BDW was noted (9.7±5.7 vs 5.1±3.6 x103 Wm-2 s-1 , p<0.01). Over 12 months, LV mass-index fell from 114±19 to 82±17 kg/m2 . Accompanying this, the BDW fraction increased to 32.8±7.2% (p=0.01 vs post-procedure) and to 34.7±6.7% at 12 months (p<0.001 vs post-procedure). CONCLUSION: In aortic stenosis, both the outflow-tract gradient and the presence of LVH impact significantly on coronary haemodynamics that cannot be appreciated by examining resting coronary flow rates alone. An immediate change in coronary wave-intensity occurs following intervention with further effects appreciable with hypertrophy regression. The improvement in prognosis with treatment is likely to be attributable to both features. This article is protected by copyright. All rights reserved.

Type: Article
Title: Regression of left ventricular hypertrophy provides an additive physiological benefit following treatment of aortic stenosis: insights from serial coronary wave-intensity analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/apha.13109
Publisher version: http://doi.org/10.1111/apha.13109
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Aortic Valve Replacement / Transcatheter Aortic Valve Implantation, Hemodynamics, Hypertrophy, Pathophysiology, Valvular Heart Disease
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10051959
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