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The Pathophysiological Alterations in Myocardial Blood Flow in Patients with Severe Aortic Stenosis

Michail, Michael; (2022) The Pathophysiological Alterations in Myocardial Blood Flow in Patients with Severe Aortic Stenosis. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Regulation of coronary blood flow is maintained through a delicate balance of ventriculoarterial and neurohumoral mechanisms. The aortic valve is integral to the functions of these systems, and disease states that compromise aortic valve integrity have the potential to adversely disrupt coronary blood flow. Aortic stenosis (AS) is the most common cause of valvular heart disease requiring medical intervention, and the prevalence and associated socioeconomic burden of AS is set to increase with population ageing. Valvular stenosis precipitates a cascade of structural, microcirculatory and neurohumoral changes, which all lead to impairment of coronary flow reserve (CFR) and myocardial ischaemia even in the absence of notable coronary stenosis. This is partially due to left ventricular hypertrophy which occurs in response to increased afterload, thus increasing resting myocardial oxygen demand. The presence of coronary disease in these patients further increases their ischaemic potential and impairs CFR. Such patients are therefore at higher risk of mismatch between oxygen supply and demand. The assessment of the physiological impact of coronary stenosis is therefore of growing interest and the methods of doing so are under current evaluation.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The Pathophysiological Alterations in Myocardial Blood Flow in Patients with Severe Aortic Stenosis
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
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
URI: https://discovery.ucl.ac.uk/id/eprint/10144085
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