Subject(s)
Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/physiopathology , Coronary Stenosis/diagnosis , Coronary Stenosis/physiopathology , Fractional Flow Reserve, Myocardial/physiology , Aorta/physiopathology , Aortic Aneurysm/physiopathology , Comorbidity , Coronary Angiography , Female , Humans , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/physiopathology , Microcirculation/physiology , Middle Aged , Prognosis , Risk AssessmentABSTRACT
A 54-year-old woman was hospitalized for an acute pulmonary oedema revealing a severe aortic stenosis (AS) associated with an aortic aneurysm and a left ventricular hypertrophy (LVH). The coronary angiography found an equivocal left main lesion. Fractional flow reserve (FFR) showed hemodynamic significance (FFR=0.78) and optical coherence tomography confirmed this result with a minimal lumen area of 4.9mm2. FFR-guided percutaneous intervention is reported to improve outcome in patients with stable coronary disease. However, only few data are available in cases of AS. In this condition, secondary LVH is associated with microcirculatory dysfunction, which interferes with optimal hyperemia. An elevated right atrial pressure could also modify FFR measurement. This risk of underestimation of a coronary lesion in patients with severe AS has to be taken into consideration in clinical practice.
Subject(s)
Aortic Aneurysm, Thoracic/physiopathology , Aortic Valve Stenosis/physiopathology , Coronary Stenosis/physiopathology , Fractional Flow Reserve, Myocardial/physiology , Hypertrophy, Left Ventricular/physiopathology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Bioprosthesis , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/surgery , Female , Heart Valve Prosthesis Implantation , Hemodynamics/physiology , Humans , Hypertrophy, Left Ventricular/diagnostic imaging , Hypertrophy, Left Ventricular/surgery , Middle Aged , Myocardial Revascularization , Pulmonary Edema/diagnostic imaging , Pulmonary Edema/physiopathology , Pulmonary Edema/surgery , Risk Factors , Tomography, Optical CoherenceABSTRACT
Cardiac troponins are the most sensitive and specific markers of myocardial injury. Cardiac troponin elevation are common in many diseases and do not necessarily indicate the presence of a thrombotic acute coronary syndrome. In clinical practice, interpretation of dynamic changes of troponin may be challenging. Troponin evaluation should be performed only if clinically indicated and must be interpreted in the context of clinical presentation, ECG changes, troponin level and kinetic. In the absence of thrombotic acute coronary syndrom, troponin retains a prognostic value. Its practical interest as a risk criteria is limited to a few situations like pulmonary embolism, pericarditis an myocarditis.