Phasic Coronary Artery Flow Profiles in Patients with Aortic Valve Disease

ABSTRACT

BACKGROUND: The previous reports have demonstrated that coronary artery flow profiles might change in patients with aortic valve disease. Our objective was to assess phasic coronary artery flow and velocity characteristics and coronary flow reserve in patients with severe aortic vale disease. METHOD: We studied six patients (4 men and 2 women, mean age 61.3+/-6.3 years) with aortic regurgitation and seven patients (3 men and 4 women, mean age 66.3+/-10.3 years) with aortic stenosis. Coronary flow velocity was measured at the proximal portion of left anterior descending artery with 0.014-inch Doppler tipped guide wire and intracoronary injection of adenosine. Nineteen patients (11 men and 8 women, mean age 52+/-9.8 years) with normal coronary artery were served as normal control. Result: The velocity-time integral of systolic coronary flow (SPVi) was significantly higher in patient with severe aortic regurgitation than control (21.1+/-5 vs 9.4+/-3.1, p<0.05, respectively) and ratio of diastlic to systolic the velocity-time integrals (DSiR) was significantly lower in patient with severe aortic regurgitation than control subject (1.5+/-0.5 vs 3.7+/- 0.8 p<0.05, respectively). Patients with severe aortic stenosis had significantly higher velocity-time integral of diastolic coronary flow (DPVi) than control subject (17+/-9.7 vs 8.8+/-3.0 p<0.05, respectively) and slighly higher DSiR than control subject (4.0+/- 2.5 vs 3.7+/-0.8 p<0.05, respectively). Coronary flow reserve was significantly decreased in patient with aortic valve disease compared with control subject (2.1+/-0.8 vs 3.2+/-0.4 p<0.05, respectively). CONCLUSION: Coronary flow reserve decreased significantly in patients with AR and with AS compared with normal control. Coronary blood flow profiles in patients with AR was characterized by systolic flow predominance and reduced diastolic flow whereas patients with AS was a tendency toward decreased systolic flow and increased diastolic flow.