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: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
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| 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. |
| format | Article |
| id | doaj-art-b4aa65c8c8484c22acc5c7c0fa6da64c |
| institution | Kabale University |
| issn | 0896-4327 1540-8183 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| 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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