TY - JOUR
T1 - Association of Myocardial Blood Flow Reserve with Adverse Left Ventricular Remodeling in Patients with Aortic Stenosis
T2 - The Microvascular Disease in Aortic Stenosis (MIDAS) Study
AU - Zhou, Wunan
AU - Sun, Yee Ping
AU - Divakaran, Sanjay
AU - Bajaj, Navkaranbir S.
AU - Gupta, Ankur
AU - Chandra, Alvin
AU - Morgan, Victoria
AU - Barrett, Leanne
AU - Martell, Laurel
AU - Bibbo, Courtney F.
AU - Hainer, Jon
AU - Lewis, Eldrin F.
AU - Taqueti, Viviany R.
AU - Dorbala, Sharmila
AU - Blankstein, Ron
AU - Slomka, Piotr
AU - Shah, Pinak B.
AU - Kaneko, Tsuyoshi
AU - Adler, Dale S.
AU - O'Gara, Patrick
AU - Di Carli, Marcelo F.
N1 - Funding Information:
Dr Kaneko reports consulting fees from Edwards Lifesciences, Medtronic, 4C Medical, CardioMech, and Cook Medical and speaker fees from Baylis and Abbott outside the submitted work. Dr Di Carli reports grants from Gilead Sciences and Spectrum Dynamics and consulting fees from Bayer and Janssen outside the submitted work. No other disclosures were reported.
Funding Information:
Author Contributions: Drs Zhou and Di Carli had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Zhou, Sun, Bajaj, Gupta, Lewis, Taqueti, Slomka, Adler, Di Carli. Acquisition, analysis, or interpretation of data: Zhou, Sun, Divakaran, Bajaj, Chandra, Morgan, Barrett, Martell, Bibbo, Hainer, Dorbala, Blankstein, Shah, Kaneko, O’Gara. Drafting of the manuscript: Zhou, Bajaj, Chandra, O’Gara, Di Carli. Critical revision of the manuscript for important intellectual content: Sun, Divakaran, Gupta, Chandra, Morgan, Barrett, Martell, Bibbo, Hainer, Lewis, Taqueti, Dorbala, Blankstein, Slomka, Shah, Kaneko, Adler, O’Gara. Statistical analysis: Zhou, Bajaj, Gupta, Chandra, Martell. Obtained funding: Adler, Di Carli. Administrative, technical, or material support: Sun, Divakaran, Morgan, Barrett, Martell, Bibbo, Hainer, Slomka, Di Carli. Supervision: Sun, Taqueti, Kaneko, O’Gara, Di Carli. Conflict of Interest Disclosures: Dr Divakaran reports grants from Harvard Catalyst and the Boston Claude D. Pepper Older Americans Independence Center during the conduct of the study, and grants from Pfizer and General Electric and consulting fees from Ionetix outside the submitted work. Dr Blankstein reports grants from Amgen and Astellas outside the submitted work. Dr Slomka reports royalties from Cedars Sinai Software and grants from Siemens Research outside the submitted work, and has a patent for Cedars-Sinai software inventions licensed to multiple parties. Dr Slomka reports grants from Abbott, Amazon Deep Learning, Edwards, Medtronic, and Siemens Research; royalties from Cedar-Sinai; and consulting fees from Edwards Lifesciences. Dr Shah reports personal fees from Edwards Life Sciences and nonfinancial support from Medtronic outside the submitted work.
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2022/1
Y1 - 2022/1
N2 - 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, (β,-0.31; P =.03; β, 0.41; P =.002, respectively). Stress MBF was associated with hs-cTnT (unadjusted β, -0.48; P =.005) and log NT-pro BNP (unadjusted β, -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.
AB - 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, (β,-0.31; P =.03; β, 0.41; P =.002, respectively). Stress MBF was associated with hs-cTnT (unadjusted β, -0.48; P =.005) and log NT-pro BNP (unadjusted β, -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.
UR - http://www.scopus.com/inward/record.url?scp=85115222053&partnerID=8YFLogxK
U2 - 10.1001/jamacardio.2021.3396
DO - 10.1001/jamacardio.2021.3396
M3 - Article
C2 - 34524397
AN - SCOPUS:85115222053
SN - 2380-6583
VL - 7
SP - 93
EP - 99
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 1
ER -