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Myocardial Ischemia in Severe Aortic Regurgitation Despite Angiographically Normal Coronary Arteries

The Tohoku Journal of Experimental Medicine, 2012, Vol.226(1), pp.69-73 [Peer Reviewed Journal]

2012 Tohoku University Medical Press ;ISSN: 0040-8727 ;EISSN: 1349-3329 ;DOI: 10.1620/tjem.226.69 ;PMID: 22200604

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Title:
Myocardial Ischemia in Severe Aortic Regurgitation Despite Angiographically Normal Coronary Arteries
Author: Aksoy, Sukru ; Cam, Nese ; Guney, Mehmet Rasit ; Gurkan, Ufuk ; Oz, Dilaver ; Poyraz, Esra ; Eksik, Abdurrahman ; Agirbasli, Mehmet
Subjects: Adult ; Aortic Valve - surgery ; Aortic Valve Insufficiency - complications ; aortic valve regurgitation ; coronary angiography ; Coronary Vessels - pathology ; Cross-Sectional Studies ; Echocardiography ; Female ; Humans ; Hypertrophy, Left Ventricular - complications ; Hypertrophy, Left Ventricular - pathology ; Male ; Middle Aged ; myocardial ischemia ; Myocardial Ischemia - epidemiology ; Myocardial Ischemia - etiology ; Myocardial Perfusion Imaging ; myocardial perfusion scintigraphy ; normal coronary arteries ; Prevalence ; Tomography, Emission-Computed
Is Part Of: The Tohoku Journal of Experimental Medicine, 2012, Vol.226(1), pp.69-73
Description: Patients with severe aortic regurgitation frequently present with angina pectoris. The exact pathophysiology for angina in aortic regurgitation is not clear. Left ventricular hypertrophy and myocardial blood supply-demand mismatch have been the suggested mechanisms to explain ischemia. However, no conclusive clinical study exists to define the incidence of ischemia in patients with severe aortic regurgitation and normal coronary arteries. We, therefore, investigated the frequency of myocardial ischemia in relation to left ventricular hypertrophy or dilatation in patients with severe aortic regurgitation and normal coronary arteries. We reviewed the medical records of all patients (n = 311) with aortic valve replacement due to aortic regurgitation between 2007 and 2010. We selected subjects with normal coronary arteries (n =182) for the study purpose, and we identified 35 patients who underwent myocardial perfusion scintigraphy prior to the coronary angiography (19 female and 16 male subjects; age 45.0 ± 8.9 years). Left ventricular hypertrophy and dilatation were detected in 9 (26%) and 5 (14%) patients, respectively. Myocardial perfusion scintigraphy showed evidence of ischemia in 10 (29%) patients with normal coronary arteries. The presence of ischemia did not relate to the presence of left ventricular hypertrophy and/or dilatation. As a potential mechanism, aortic regurgitation causes backflow of blood from the aorta into the left ventricle, hence disturbs coronary flow dynamics. In conclusion, myocardial ischemia is common (nearly one-third) among patients with severe aortic regurgitation even in the absence of coronary obstruction, left ventricular hypertrophy and/or dilatation.
Publisher: Japan: Tohoku University Medical Press
Language: English
Identifier: ISSN: 0040-8727
EISSN: 1349-3329
DOI: 10.1620/tjem.226.69
PMID: 22200604
Source: Freely Accessible Japanese Titles (ERDB Project)
GFMER Free Medical Journals
MEDLINE
Alma/SFX Local Collection

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Myocardial Ischemia in Severe Aortic Regurgitation Despite Angiographically Normal Coronary Arteries

2012 Tohoku University Medical Press ;ISSN: 0040-8727 ;EISSN: 1349-3329 ;DOI: 10.1620/tjem.226.69 ;PMID: 22200604

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