Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions

With the increasing prevalence of aortic stenosis (AS) due to a growing elderly population, a proper understanding of its physiology is paramount to guide therapy and define severity. A better understanding of the microvasculature in AS could improve clinical care by predicting left ventricular remo...

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Main Authors: Jo M. Zelis, Pim A. L. Tonino, Nico H. J. Pijls, Bernard De Bruyne, Richard L. Kirkeeide, K. Lance Gould, Nils P. Johnson
Format: Article
Language:English
Published: Wiley 2020-01-01
Series:Journal of Interventional Cardiology
Online Access:http://dx.doi.org/10.1155/2020/4603169
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author Jo M. Zelis
Pim A. L. Tonino
Nico H. J. Pijls
Bernard De Bruyne
Richard L. Kirkeeide
K. Lance Gould
Nils P. Johnson
author_facet Jo M. Zelis
Pim A. L. Tonino
Nico H. J. Pijls
Bernard De Bruyne
Richard L. Kirkeeide
K. Lance Gould
Nils P. Johnson
author_sort Jo M. Zelis
collection DOAJ
description With the increasing prevalence of aortic stenosis (AS) due to a growing elderly population, a proper understanding of its physiology is paramount to guide therapy and define severity. A better understanding of the microvasculature in AS could improve clinical care by predicting left ventricular remodeling or anticipate the interplay between epicardial stenosis and myocardial dysfunction. In this review, we combine five decades of literature regarding microvascular, coronary, and aortic valve physiology with emerging insights from newly developed invasive tools for quantifying microcirculatory function. Furthermore, we describe the coupling between microcirculation and epicardial stenosis, which is currently under investigation in several randomized trials enrolling subjects with concomitant AS and coronary disease. To clarify the physiology explained previously, we present two instructive cases with invasive pressure measurements quantifying coexisting valve and coronary stenoses. Finally, we pose open clinical and research questions whose answers would further expand our knowledge of microvascular dysfunction in AS. These trials were registered with NCT03042104, NCT03094143, and NCT02436655.
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institution Kabale University
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publishDate 2020-01-01
publisher Wiley
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spelling doaj-art-b4aa65c8c8484c22acc5c7c0fa6da64c2025-02-03T06:46:33ZengWileyJournal of Interventional Cardiology0896-43271540-81832020-01-01202010.1155/2020/46031694603169Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future DirectionsJo M. Zelis0Pim A. L. Tonino1Nico H. J. Pijls2Bernard De Bruyne3Richard L. Kirkeeide4K. Lance Gould5Nils P. Johnson6Department of Cardiology, Catharina Hospital, Eindhoven, NetherlandsDepartment of Cardiology, Catharina Hospital, Eindhoven, NetherlandsDepartment of Cardiology, Catharina Hospital, Eindhoven, NetherlandsDepartment of Cardiology, Cardiovascular Center Aalst OLV Hospital, Aalst, BelgiumWeatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USAWeatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USAWeatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USAWith the increasing prevalence of aortic stenosis (AS) due to a growing elderly population, a proper understanding of its physiology is paramount to guide therapy and define severity. A better understanding of the microvasculature in AS could improve clinical care by predicting left ventricular remodeling or anticipate the interplay between epicardial stenosis and myocardial dysfunction. In this review, we combine five decades of literature regarding microvascular, coronary, and aortic valve physiology with emerging insights from newly developed invasive tools for quantifying microcirculatory function. Furthermore, we describe the coupling between microcirculation and epicardial stenosis, which is currently under investigation in several randomized trials enrolling subjects with concomitant AS and coronary disease. To clarify the physiology explained previously, we present two instructive cases with invasive pressure measurements quantifying coexisting valve and coronary stenoses. Finally, we pose open clinical and research questions whose answers would further expand our knowledge of microvascular dysfunction in AS. These trials were registered with NCT03042104, NCT03094143, and NCT02436655.http://dx.doi.org/10.1155/2020/4603169
spellingShingle Jo M. Zelis
Pim A. L. Tonino
Nico H. J. Pijls
Bernard De Bruyne
Richard L. Kirkeeide
K. Lance Gould
Nils P. Johnson
Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions
Journal of Interventional Cardiology
title Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions
title_full Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions
title_fullStr Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions
title_full_unstemmed Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions
title_short Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions
title_sort coronary microcirculation in aortic stenosis pathophysiology invasive assessment and future directions
url http://dx.doi.org/10.1155/2020/4603169
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AT nicohjpijls coronarymicrocirculationinaorticstenosispathophysiologyinvasiveassessmentandfuturedirections
AT bernarddebruyne coronarymicrocirculationinaorticstenosispathophysiologyinvasiveassessmentandfuturedirections
AT richardlkirkeeide coronarymicrocirculationinaorticstenosispathophysiologyinvasiveassessmentandfuturedirections
AT klancegould coronarymicrocirculationinaorticstenosispathophysiologyinvasiveassessmentandfuturedirections
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