Brennan J. Vogl BS , Alejandra Chavez-Ponce MD , Adam Wentworth MS , Eric Erie AAS , Pradeep Yadav MD , Vinod H. Thourani MD , Lakshmi Prasad Dasi PhD , Brian Lindman MD, MSc , Mohamad Alkhouli MD , Hoda Hatoum PhD
{"title":"经导管主动脉瓣置换术后血压控制目标对心外膜冠脉流量的不同影响","authors":"Brennan J. Vogl BS , Alejandra Chavez-Ponce MD , Adam Wentworth MS , Eric Erie AAS , Pradeep Yadav MD , Vinod H. Thourani MD , Lakshmi Prasad Dasi PhD , Brian Lindman MD, MSc , Mohamad Alkhouli MD , Hoda Hatoum PhD","doi":"10.1016/j.shj.2023.100230","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The cause for the association between increased cardiovascular mortality rates and lower blood pressure (BP) after aortic valve replacement (AVR) is unclear. This study aims to assess how the epicardial coronary flow (ECF) after AVR varies as BP levels are changed in the presence of a right coronary lesion.</p></div><div><h3>Methods</h3><p>The hemodynamics of a 3D printed aortic root model with a SAPIEN 3 26 deployed were evaluated in an <em>in vitro</em> left heart simulator under a range of varying systolic blood pressure (SBP) and diastolic blood pressure (DBP). ECF and the flow ratio index were calculated. Flow index value <0.8 was considered a threshold for ischemia.</p></div><div><h3>Results</h3><p>As SBP decreased, the average ECF decreased below the physiological coronary minimum at 120 mmHg. As DBP decreased, the average ECF was still maintained above the physiological minimum. The flow ratio index was >0.9 for SBP ≥130 mmHg. However, at an SBP of 120 mmHg, the flow ratio was 0.63 (<em>p</em> ≤ 0.0055). With decreasing DBP, no BP condition yielded a flow ratio index that was less than 0.91.</p></div><div><h3>Conclusions</h3><p>Reducing BP to the current recommended levels assigned for the general population after AVR in the presence of coronary artery disease may require reconsideration of levels and treatment priority. Additional studies are needed to fully understand the changes in ECF dynamics after AVR in the presence and absence of coronary artery disease.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 1","pages":"Article 100230"},"PeriodicalIF":1.4000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870623001240/pdfft?md5=f196d452263fee2a8a6454519e119567&pid=1-s2.0-S2474870623001240-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Differential Impact of Blood Pressure Control Targets on Epicardial Coronary Flow After Transcatheter Aortic Valve Replacement\",\"authors\":\"Brennan J. Vogl BS , Alejandra Chavez-Ponce MD , Adam Wentworth MS , Eric Erie AAS , Pradeep Yadav MD , Vinod H. Thourani MD , Lakshmi Prasad Dasi PhD , Brian Lindman MD, MSc , Mohamad Alkhouli MD , Hoda Hatoum PhD\",\"doi\":\"10.1016/j.shj.2023.100230\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The cause for the association between increased cardiovascular mortality rates and lower blood pressure (BP) after aortic valve replacement (AVR) is unclear. This study aims to assess how the epicardial coronary flow (ECF) after AVR varies as BP levels are changed in the presence of a right coronary lesion.</p></div><div><h3>Methods</h3><p>The hemodynamics of a 3D printed aortic root model with a SAPIEN 3 26 deployed were evaluated in an <em>in vitro</em> left heart simulator under a range of varying systolic blood pressure (SBP) and diastolic blood pressure (DBP). ECF and the flow ratio index were calculated. Flow index value <0.8 was considered a threshold for ischemia.</p></div><div><h3>Results</h3><p>As SBP decreased, the average ECF decreased below the physiological coronary minimum at 120 mmHg. As DBP decreased, the average ECF was still maintained above the physiological minimum. The flow ratio index was >0.9 for SBP ≥130 mmHg. However, at an SBP of 120 mmHg, the flow ratio was 0.63 (<em>p</em> ≤ 0.0055). With decreasing DBP, no BP condition yielded a flow ratio index that was less than 0.91.</p></div><div><h3>Conclusions</h3><p>Reducing BP to the current recommended levels assigned for the general population after AVR in the presence of coronary artery disease may require reconsideration of levels and treatment priority. Additional studies are needed to fully understand the changes in ECF dynamics after AVR in the presence and absence of coronary artery disease.</p></div>\",\"PeriodicalId\":36053,\"journal\":{\"name\":\"Structural Heart\",\"volume\":\"8 1\",\"pages\":\"Article 100230\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2474870623001240/pdfft?md5=f196d452263fee2a8a6454519e119567&pid=1-s2.0-S2474870623001240-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Structural Heart\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2474870623001240\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Structural Heart","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2474870623001240","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Differential Impact of Blood Pressure Control Targets on Epicardial Coronary Flow After Transcatheter Aortic Valve Replacement
Background
The cause for the association between increased cardiovascular mortality rates and lower blood pressure (BP) after aortic valve replacement (AVR) is unclear. This study aims to assess how the epicardial coronary flow (ECF) after AVR varies as BP levels are changed in the presence of a right coronary lesion.
Methods
The hemodynamics of a 3D printed aortic root model with a SAPIEN 3 26 deployed were evaluated in an in vitro left heart simulator under a range of varying systolic blood pressure (SBP) and diastolic blood pressure (DBP). ECF and the flow ratio index were calculated. Flow index value <0.8 was considered a threshold for ischemia.
Results
As SBP decreased, the average ECF decreased below the physiological coronary minimum at 120 mmHg. As DBP decreased, the average ECF was still maintained above the physiological minimum. The flow ratio index was >0.9 for SBP ≥130 mmHg. However, at an SBP of 120 mmHg, the flow ratio was 0.63 (p ≤ 0.0055). With decreasing DBP, no BP condition yielded a flow ratio index that was less than 0.91.
Conclusions
Reducing BP to the current recommended levels assigned for the general population after AVR in the presence of coronary artery disease may require reconsideration of levels and treatment priority. Additional studies are needed to fully understand the changes in ECF dynamics after AVR in the presence and absence of coronary artery disease.
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