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Invasive assessment of microvascular function in patients with valvular heart disease

Nishi, Takeshia; Kitahara, Hidekia; Saito, Yuichia; Nishi, Tomokoa; Nakayama, Takashia; Fujimoto, Yoshihidea; Matsumiya, Gorob; Kobayashi, Yoshioa

doi: 10.1097/MCA.0000000000000594
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Background The aim of this study was to investigate microvascular function in patients with valvular heart disease (VHD), which causes chronic left ventricular volume and/or pressure overload, therefore change in coronary microvascular hemodynamics.

Patients and methods We prospectively enrolled 30 patients with VHD considered for surgery (10 aortic stenosis, 12 aortic regurgitation, and eight mitral regurgitation) and 30 controls. Intracoronary physiological assessments were performed in the unobstructed left anterior descending artery using a pressure–temperature sensor guidewire at rest and hyperemia.

Results The index of microcirculatory resistance (IMR) was similar between the two groups (16.2±6.5 vs. 16.2±8.5, P=0.997), whereas coronary flow reserve (CFR) was lower in the VHD group compared with the controls (3.2±1.4 vs. 4.3±1.7, P=0.005). Resting and hyperemic coronary distal pressure, and hyperemic mean transit time were similar between VHD and controls, whereas resting mean transit time was significantly shorter (0.70±0.29 vs. 0.89±0.39, P=0.035) and baseline resting microvascular resistance was significantly lower in the VHD group compared with the controls (58.1±25.4 vs. 78.1±36.7, P=0.011). Patients with aortic stenosis showed numerically higher IMR values than aortic regurgitation, mitral regurgitation, and controls, although this was not statistically significant (20.4±6.9, P=0.14). CFR was significantly correlated with log high-sensitivity cardiac troponin T levels in patients with VHD (r=−0.523, P=0.004).

Conclusion CFR was reduced in patients with VHD compared with controls, despite similar microvascular function as assessed by IMR. This appeared to be mainly because of an increased resting coronary flow accompanied by a decreased resting coronary microvascular resistance rather than microvascular disease.

Departments of aCardiovascular Medicine

bCardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan

Correspondence to Takeshi Nishi, MD, Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan Tel/fax: +81 43 226 2340; e-mail: takeshi24@hotmail.co.jp

Received November 2, 2017

Received in revised form November 10, 2017

Accepted November 14, 2017

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