Myocardial Blood Flow Reserve Is Impaired in Patients With Aortic Valve Calcification and Unobstructed Epicardial Coronary Arteries.

Nel, K., Nam, M.C.Y., Anstey, C., Boos, C.J., Carlton, E., Senior, R., Carlos Kaski, J., Khattab, A., Shamley, D., Byrne, C.D., Stanton, T. and Greaves, K., 2017. Myocardial Blood Flow Reserve Is Impaired in Patients With Aortic Valve Calcification and Unobstructed Epicardial Coronary Arteries. International Journal of Cardiology, 248, 427- 432.

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DOI: 10.1016/j.ijcard.2017.06.023

Abstract

Background: Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of CMD, and early CAVD. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation. Methods: 183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay. Results: Mean(±SD) participant age was 59.8(9.6) years. Mean AVCS was 68(258) AU, TPL was 15.6(22.2) mm, and median coronary calcification score was 43.5AU. Mean MBFR was 2.20(0.52). Mean hs-CRP was 2.52(3.86) mg/L. Multivariable linear regression modelling incorporating demographics, coronary plaque characteristics, MBFR, and inflammatory markers, demonstrated that age (β=0.05, 95%CI:0.02,0.08, P=0.007), hs-CRP (β=0.09, CI:0.02,0.16, P=0.010) and diabetes (β=1.03, CI:0.08,1.98, P=0.033), were positively associated with AVCS. MBFR (β=-0.87, CI:-1.44,-0.30, P=0.003), BMI (β=-0.11, CI:-0.21,-0.01, P=0.033), and LDL (β=-0.32, CI:-0.61,-0.03, P=0.029) were negatively associated with AVCS. TPL and coronary calcium score were not independently associated with AVCS when included in the regression model. Conclusion: Coronary microvascular function as determined by measurement of myocardial blood flow reserve is an independent predictor of early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation.

Item Type:Article
ISSN:0167-5273
Additional Information:Grant support: Bournemouth University PhD Scholarship, The Dorset Research Consortium and the Poole Hospital Cardiology Research Fund
Uncontrolled Keywords:Aortic valve calcification score; coronary microvascular dysfunction; calcific aortic valve disease
Group:Faculty of Health & Social Sciences
ID Code:30937
Deposited By: Unnamed user with email symplectic@symplectic
Deposited On:04 Jul 2018 15:07
Last Modified:04 Jul 2018 15:44

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