Systolic Coronary Flow Reversal and Abnormal Diastolic Flow Patterns in Patients With Aortic Stenosis: Assessment With an Intracoronary Doppler Catheter

Abstract

Decreased left ventricular coronary flow reserve has been reported in patients with normal coronary arteries and left ventricular hypertrophy in association with aortic stenosis. However, phasic coronary flow characteristics have not been analyzed in detail in similar patients. The purpose of this study is to assess phasic coronary flow characteristics and their relation to hemodynamic parameters in patients with aortic stenosis. Coronary flow velocities were recorded in the left anterior descending artery with a 20 MHz Doppler catheter in nine patients with aortic stenosis and nine control subjects with normal coronary arteries. Patient aortic valve area ranged from 0.34 to 0.51 cm2. Flow reversal was observed in systole in all patients with aortic stenosis, and time velocity integrals of systolic flow were significantly smaller in patients with aortic stenosis than in controls (-0.3 +/- 2.3 vs 4.0 +/- 1.1 cm, p < 0.01). The time to peak diastolic velocity corrected by square root R-R interval was prolonged and the velocity half-time from peak diastolic velocity corrected by square root R-R interval was shorter in patients with aortic stenosis than in controls (5.3 +/- 1.1 vs 4.0 +/- 0.5, p < 0.01, 8.0 +/- 2.6 vs 13.0 +/- 3.3, p < 0.01, respectively). Peak velocity and time velocity integral of flow reversal showed significant correlations with mean pressure gradient across the aortic valve (y = 1.3x + 37.3, r = 0.72, p = 0.03, y = 11.3x + 41.2, r = 0.81, p < 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)