Myocardial perfusion and oxygenation are impaired during stress in severe aortic stenosis and correlate with impaired energetics and subclinical left ventricular dysfunction

Journal of Cardiovascular Magnetic Resonance

Theodoros D Karamitsos¹  Stefan Neubauer¹  Houman Ashrafian¹  Matthew D Robson¹  Stephen Westaby²  Rana Sayeed²  Mario Petrou²  Ravi De Silva²  Sairia Dass¹  Andrew Lewis¹  Nikhil Pal¹  Jane M Francis¹  Masliza Mahmod¹ 

[1] Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford OX3 9DU, UK;Department of Cardiothoracic Surgery, Oxford University Hospitals, Oxford OX3 9DU, UK

关键词: Strain;    Energetics;    Oxygenation;    Microvascular dysfunction;    Myocardial ischaemia;    Hypertrophy;   

Others  :  801359
DOI  :  10.1186/1532-429X-16-29

 received in 2014-01-21, accepted in 2014-04-17,  发布年份 2014

【 摘 要 】

Background

Left ventricular (LV) hypertrophy in aortic stenosis (AS) is characterized by reduced myocardial perfusion reserve due to coronary microvascular dysfunction. However, whether this hypoperfusion leads to tissue deoxygenation is unknown. We aimed to assess myocardial oxygenation in severe AS without obstructive coronary artery disease, and to investigate its association with myocardial energetics and function.

Methods

Twenty-eight patients with isolated severe AS and 15 controls underwent cardiovascular magnetic resonance (CMR) for assessment of perfusion (myocardial perfusion reserve index-MPRI) and oxygenation (blood-oxygen level dependent-BOLD signal intensity-SI change) during adenosine stress. LV circumferential strain and phosphocreatine/adenosine triphosphate (PCr/ATP) ratios were assessed using tagging CMR and ³¹P MR spectroscopy, respectively.

Results

AS patients had reduced MPRI (1.1 ± 0.3 vs. controls 1.7 ± 0.3, p < 0.001) and BOLD SI change during stress (5.1 ± 8.9% vs. controls 18.2 ± 10.1%, p = 0.001), as well as reduced PCr/ATP (1.45 ± 0.21 vs. 2.00 ± 0.25, p < 0.001) and LV strain (−16.4 ± 2.7% vs. controls −21.3 ± 1.9%, p < 0.001). Both perfusion reserve and oxygenation showed positive correlations with energetics and LV strain. Furthermore, impaired energetics correlated with reduced strain. Eight months post aortic valve replacement (AVR) (n = 14), perfusion (MPRI 1.6 ± 0.5), oxygenation (BOLD SI change 15.6 ± 7.0%), energetics (PCr/ATP 1.86 ± 0.48) and circumferential strain (−19.4 ± 2.5%) improved significantly.

Conclusions

Severe AS is characterized by impaired perfusion reserve and oxygenation which are related to the degree of derangement in energetics and associated LV dysfunction. These changes are reversible on relief of pressure overload and hypertrophy regression. Strategies aimed at improving oxygen demand–supply balance to preserve myocardial energetics and LV function are promising future therapies.

【 授权许可】

   
2014 Mahmod et al.; licensee BioMed Central Ltd.

【 图 表 】

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