Association of Myocardial Blood Flow Reserve With Adverse Left Ventricular Remodeling in Patients With Aortic Stenosis The Microvascular Disease in Aortic Stenosis (MIDAS) Study

被引:18
作者
Zhou, Wunan [1 ,2 ]
Sun, Yee-Ping [1 ]
Divakaran, Sanjay [1 ]
Bajaj, Navkaranbir S. [1 ]
Gupta, Ankur [1 ]
Chandra, Alvin [1 ,3 ]
Morgan, Victoria [1 ]
Barrett, Leanne [1 ]
Martell, Laurel [1 ]
Bibbo, Courtney F. [1 ]
Hainer, Jon [1 ]
Lewis, Eldrin F. [1 ,4 ]
Taqueti, Viviany R. [1 ]
Dorbala, Sharmila [1 ]
Blankstein, Ron [1 ]
Slomka, Piotr [5 ]
Shah, Pinak B. [1 ]
Kaneko, Tsuyoshi [1 ]
Adler, Dale S. [1 ]
O'Gara, Patrick [1 ,6 ]
Di Carli, Marcelo F. [1 ]
机构
[1] Harvard Med Sch, Brigham & Womens Hosp, Div Cardiac Surg Heart & Vasc Ctr, Div Cardiovasc Med,Cardiovasc Imaging Program, Boston, MA 02115 USA
[2] NHLBI, NIH, Div Intramural Res, Cardiol Branch, Bldg 10, Bethesda, MD 20892 USA
[3] Univ Texas Southwestern Med Ctr Dallas, Dept Internal Med, Div Cardiol, Dallas, TX 75390 USA
[4] Stanford Univ, Div Cardiovasc Med, Palo Alto, CA 94304 USA
[5] Cedars Sinai Med Ctr, Div Artificial Intelligence Med, Dept Med & Cardiol, Los Angeles, CA USA
[6] JAMA Cardiol, Chicago, IL USA
基金
美国国家卫生研究院;
关键词
PERFUSION RESERVE; VALVE-REPLACEMENT; DYSFUNCTION; MARKER;
D O I
10.1001/jamacardio.2021.3396
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE Impaired myocardial flow reserve (MFR) and stress myocardial blood flow (MBF) on positron emission tomography (PET) myocardial perfusion imaging may identify adverse myocardial characteristics, including myocardial stress and injury in aortic stenosis (AS). OBJECTIVE To investigate whether MFR and stress MBF are associated with LV structure and function derangements, and whether these parameters improve after aortic valve replacement (AVR). DESIGN, SETTING, AND PARTICIPANTS In this single-center prospective observational study in Boston, Massachusetts, from 2018 to 2020, patients with predominantly moderate to severe AS underwent ammonia N13 PET myocardial perfusion imaging for myocardial blood flow (MBF) quantification, resting transthoracic echocardiography (TTE) for assessment of myocardial structure and function, and measurement of circulating biomarkers for myocardial injury and wall stress. Evaluation of health status and functional capacity was also performed. A subset of patients underwent repeated assessment 6 months after AVR. A control group included patients without AS matched for age, sex, and summed stress score who underwent symptom-prompted ammonia N13 PET and TTE within 90 days. EXPOSURES MBF and MFR quantified on ammonia N13 PET myocardial perfusion imaging. MAIN OUTCOMES AND MEASURES LV structure and function parameters, including echocardiographic global longitudinal strain (GLS), circulating high-sensitivity troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-pro BNP), health status, and functional capacity. RESULTS There were 34 patients with AS (1 mild, 9 moderate, and 24 severe) and 34 matched control individuals. MFR was independently associated with GLS and LV ejection fraction, (beta,-0.31; P = .03; beta, 0.41; P = .002, respectively). Stress MBF was associated with hs-cTnT (unadjusted beta, -0.48; P = .005) and log NT-pro BNP (unadjusted beta, -0.37; P = .045). The combination of low stress MBF and high hs-cTnT was associated with higher interventricular septal thickness in diastole, relative wall thickness, and worse GLS compared with high stress MBF and low hs-cTnT (12.4 mm vs 10.0 mm; P = .008; 0.62 vs 0.46; P = .02; and -13.47 vs -17.11; P = .006, respectively). In 9 patients studied 6 months after AVR, mean (SD) MFR improved from 1.73 (0.57) to 2.11 (0.50) (P = .008). CONCLUSIONS and Relevance In this study, in AS, MFR and stress MBF were associated with adverse myocardial characteristics, including markers of myocardial injury and wall stress, suggesting that MFR may be an early sensitive marker for myocardial decompensation.
引用
收藏
页码:93 / 99
页数:7
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